| Doctor Name: | SANDRA CLARK |
| NPI Number: | 1578692463 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RT(R) |
| License Number: | MRT2279 |
| Business Practice Address: | 139 County Road 379 Water Valley, MS - 389653607 |
| Business Phone Number: | 6625145215 |
| Business Fax Number: | |
| Mailing Address: | 139 County Road 379, WATER VALLEY |
| State: | MS |
| Postal Code: | 389653607 |
| Phone Number: | 6625145215 |
| Fax Number: | |
| NPI Enumeration Date: | 03/05/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471C3402X |
| License Number: | MRT2279 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Radiography |
| Taxonomy Definition: | |