| Doctor Name: | DANIEL JAMES CLARK |
| NPI Number: | 1003017229 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | |
| Business Practice Address: | 5330 S Highway 95 Fort Mohave, AZ - 864269225 |
| Business Phone Number: | 9287887115 |
| Business Fax Number: | 7708745483 |
| Mailing Address: | 5665 New Northside Dr, Suite 320 ATLANTA |
| State: | GA |
| Postal Code: | 303285831 |
| Phone Number: | 7708745400 |
| Fax Number: | 7708745483 |
| NPI Enumeration Date: | 05/29/2007 |
| NPI Last Update Date: | 12/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AR |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |