| Organization Name: | M CLARK COLVARD JR MD PC |
| NPI Number: | 1487812517 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | M CLARK COLVARD (OWNER) |
| Mailing Address: | 102 Gross Crescent Cir Suite 300 Fort Oglethorpe |
| State: | GA US |
| Postal Code: | 307423670 |
| Phone Number: | 7068611726 |
| Fax Number: | 7068612224 |
| NPI Enumeration Date: | 05/27/2008 |
| NPI Last Update Date: | 07/28/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 16957 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |