Individual
GEORGE L CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
8740 RIVERS AVE, NORTH CHARLESTON, SC 29406-9211
(843) 572-5990
(843) 572-2928
Mailing address
8740 RIVERS AVE, NORTH CHARLESTON, SC 29406-9211
(843) 572-5990
(843) 572-2928
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0264
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002641
—
SC
Enumeration date
07/05/2005
Last updated
03/10/2008
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