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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

NPI # 1326079039
LBN Legal business name ROBERT B CLARK JR MD LLC
Authorized official PRISCILLA EDGE - (CREDENTIALING)
Entity Organization
Organization subpart 1 No
Enumeration date 07/05/2006
Last updated 03/27/2013 - About 13 years ago
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 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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