# PREMIERE SPINE AND SPORTS MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245760875
- **Authorized official:** DR. CHRISTOPHER DAVID CLARK MD (OWNER/PHYSICIAN)
- **Authorized official phone:** (252) 295-8685

## Contact information

- **Practice address:** 13114 PENNSYLVANIA AVE, HAGERSTOWN, MD 21742-2741
- **Practice address phone:** (301) 800-7770
- **Mailing address:** 13114 PENNSYLVANIA AVE, HAGERSTOWN, MD 21742-3720
- **Mailing address phone:** (301) 800-7770
- **Mailing address fax:** (301) 800-7891

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | MD | Yes |

## Other

- **Enumeration date:** 06/15/2017
- **Last updated:** 11/21/2024