Individual
MR. PHILLIP DOUGLAS CLARK SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2126 HIGHWAY 9 E UNIT 5B, LONGS, SC 29568-5725
(843) 353-8664
(843) 485-0047
Mailing address
3988 TYBRE CT, LITTLE RIVER, SC 29566-8483
(843) 353-8664
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
1264
SC
374U00000X
Home Health Aide
1264
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104613648
DRIVER LICENSE
SC
Enumeration date
11/03/2020
Last updated
11/03/2020
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