Provider Demographics
NPI:1922080993
Name:WORLEY, CLARENCE MACDONALD JR (MD)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:MACDONALD
Last Name:WORLEY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:156 FENCERAIL GAP
Mailing Address - Street 2:
Mailing Address - City:WALLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37886-2510
Mailing Address - Country:US
Mailing Address - Phone:678-524-5077
Mailing Address - Fax:
Practice Address - Street 1:205 SOUTHDOWNE DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-3747
Practice Address - Country:US
Practice Address - Phone:678-524-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN9764125Q00000X
TN51786204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No125Q00000XDental ProvidersDentistOral Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG59791Medicare UPIN