National Provider Identifier Database

ROBERT B CLARK JR MD LLC
Specialist

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.


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
* Specialist 174400000X

* Indicates primary specialty

NPI Profile & details for ROBERT B CLARK JR MD LLC

NPI Number 1326079039
Legal business name
LBN
ROBERT B CLARK JR MD LLC
Authorized official PRISCILLA EDGE - (CREDENTIALING)
Entity Organization
Organization subpart No
Enumeration date 07/05/2006
Last updated 03/27/2013 - About 13 years ago
Sole proprietor1 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

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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