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Contact Information

MARSHALL B CLACK II II
1075 S MAIN ST
ST 100
MADISON, GA30650-2033
 Phone: 706-752-0322
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Contractor

171W00000X
Indicates primary specialty

NPI Profile & details for MARSHALL B CLACK II II · (Male)

NPI Number 1275963514
Status Active
Credentials
Entity Individual
Enumeration date 11/23/2013
Last updated 11/23/2013 - About 13 years ago
Sole proprietor 1 Yes
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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