Basic Information
| Provider Information | |||||||||
| NPI: | 1285602953 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMAHON | ||||||||
| FirstName: | CLETUS | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 VERMONT AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654812541 | ||||||||
| FaxNumber: | 8654838151 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 VERMONT AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654812541 | ||||||||
| FaxNumber: | 8654838151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 06/22/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD9051 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200029629 | 01 | TN | RAILROAD MEDICARE | OTHER | 3071421 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 4034705 | 01 | TN | AETNA | OTHER | 100010938 | 01 | TN | TENNCARE | OTHER | 3168046 | 05 | TN | MEDICAID | 296033 | 01 | TN | UNITED HEALTH CARE | OTHER |