Individual
DR. MATTHEW TAYLOR CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
616 EDGEFIELD RD, SUITE 180, NORTH AUGUSTA, SC 29841-1938
(803) 279-7666
(803) 279-0708
Mailing address
130 ALLEN CT, NORTH AUGUSTA, SC 29860-9782
(803) 279-7666
(803) 279-0708
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
057156
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053433250
—
SC
Enumeration date
04/06/2007
Last updated
07/29/2020
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