Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tavis D. Clonch, PA

Individual provider Physician Assistant · NPI 1629752514

Tavis D. Clonch, PA is a Physician Assistant in Johnson City, Tennessee. Qualified in 2023, 3 years ago. Practices with Campbell Clinic, PC, a 225-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Tennessee and Virginia.

Years since qualifying
3
Licensed in
TN, VA
In the registry since
2023
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

701 Med Tech Pkwy Ste 300
Johnson City, TN 37604-2365
Phone: (423) 232-8301
Fax: (423) 232-8304
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 1 Medical Park Blvd Ste 300e, Bristol, TN 37620-7497 — (423) 844-6450
  • 444 Clinchfield St Ste 103, Kingsport, TN 37660-3859 — (423) 578-1518

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5560 (TN)
Physician Assistant Taxonomy 363A00000X · Licence 0110009515 (VA)

Record details

NPI number1629752514
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJune 12, 2023
Last updated in NPPESJune 15, 2026
Certification dateJune 15, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Campbell Clinic, Pc — 225 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Johnson City