Basic Information
| Provider Information | |||||||||
| NPI: | 1891767794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACCONNELL | ||||||||
| FirstName: | CLAYTON | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 STEAM PLANT RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GALLATIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370663032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152308070 | ||||||||
| FaxNumber: | 6154521774 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 STEAM PLANT RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GALLATIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370663032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152308070 | ||||||||
| FaxNumber: | 6154521774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD17254 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3021676 | 05 | TN | MEDICAID |