Doctor Name: | DR. JAMES M. CLARK |
NPI Number: | 1811101231 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 57-011938 |
Business Practice Address: | 699 E Poplar Ave Selmer, TN - 383751828 |
Business Phone Number: | 7316453020 |
Business Fax Number: | 7316453494 |
Mailing Address: | 699 E Poplar Ave, SELMER |
State: | TN |
Postal Code: | 383751828 |
Phone Number: | 7316453020 |
Fax Number: | 7316453494 |
NPI Enumeration Date: | 05/09/2007 |
NPI Last Update Date: | 09/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 57-011938 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
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. |