Provider Demographics
NPI:1366546046
Name:MUSIL, CLINTON ALLEN JR (MD)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:ALLEN
Last Name:MUSIL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:109 WEST WATAUGA AVENUE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-232-2600
Practice Address - Fax:423-232-2646
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012400182084P0804X, 208000000X, 2084P0800X
TN291502084P0804X, 2084P0800X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
043641OtherVALUE OPTIONS CBHP
334969OtherVALUE OPTIONS
620582605OtherCARITEN PHP WORKCO
TN1517319Medicaid
3085205OtherMAGELLAN NAVIGATOR
49866OtherUBH EMPLOYER
620582605OtherCARITEN PHP POS
3085205OtherMAGELLAN SUMMIT
TN38174601Medicaid
49866OtherUBH SENIOR
VA010264626Medicaid
620582605OtherCARITEN PHP PPO
620582605OtherCARITEN PHP HMO
043641OtherVALUE OPTIONS MED
1050956OtherCIGNA MCC
3085205OtherMAGELLAN PINNACLE
043641OtherVALUE OPTIONS
1125291OtherFIRST HEALTH
49866OtherUBH HEALTHPLAN
F66921Medicare UPIN
TN103I268731Medicare PIN
TN103I263081Medicare PIN
3085205OtherMAGELLAN PINNACLE