Individual
MR. TERRY LEE CLARK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
109 BEE ST, CHARLESTON, SC 29401-5703
(843) 789-7330
Mailing address
5711 CAPTAIN KIDD RD, HOLLYWOOD, SC 29449-6803
(843) 696-4290
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
A475
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
QM0402
—
SC
Enumeration date
07/18/2005
Last updated
02/04/2008
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