Organization
J MADISON CLARK MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SONJA D THOMPSON (PRACTICE ADMINISTRATOR)
(336) 538-1966
Entity
Organization
Contact information
Practice address
1248 HUFFMAN MILL RD, SUITE 201, BURLINGTON, NC 27215-8700
(336) 538-1966
(336) 538-1729
Mailing address
PO BOX 24848, WINSTON SALEM, NC 27114-4848
(336) 538-1966
(336) 538-1729
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
9700217
NC
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
9700217
NC
Other
Enumeration date
05/07/2014
Last updated
07/23/2014
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