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Contact Information

ROBERT B CLARK JR MD LLC
1811 MANNING DRIVE
VIDALIA, GA30474
 Phone: 912-537-6634
 Fax: 912-537-1909
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Specialist

174400000X
Indicates primary specialty

NPI Profile & details for ROBERT B CLARK JR MD LLC · (Female)

NPI Number 1326079039
Status Active
Credentials
Entity Individual
Enumeration date 07/05/2006
Last updated 03/27/2013 - About 13 years ago
Sole proprietor 1 Not specified
Identifiers
  • GA License # 020521
  • GA Medicaid 000177713D
  • GA Other 449866340 MEDICAID REFERRAL
  • GA Other GRP7739 MEDICARE GROUP NUMBER
  • GU Other 1144289349 PERSONAL NPI NUMBER 1144289349
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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