Active NPI
Tyler Clemmons, LCSW
- Social Worker
- Chattanooga, TN
National Provider Identifier
1578032736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 7358
- Practice address
- 6110 Shallowford Rd Ste B
Chattanooga, TN 37421-1894 - Phone
- (205) 213-4062
- NPI assigned
- Nov 17, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 10917 | TN | |
| Social Worker | 104100000X | 7358 | TN | Primary |
Addresses
Primary practice location
6110 Shallowford Rd Ste B
Chattanooga, TN 37421-1894
Mailing address
6110 Shallowford Rd Ste B
Chattanooga, TN 37421-1894
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10917 | TN | MD | Social Worker |
| 7358 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604966400000",
"number": "1578032736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6110 SHALLOWFORD RD STE B",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374211894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6110 SHALLOWFORD RD STE B",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374211894",
"telephone_number": "205-213-4062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEMMONS",
"first_name": "TYLER",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-11-17",
"last_updated": "2020-11-10",
"certification_date": "2020-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TN",
"license": "10917",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TN",
"license": "7358",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chattanooga, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.