Individual
CLARK ALAN BERNIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1900 10TH AVE, STE 120, COLUMBUS, GA 31901-3600
(706) 323-6914
(706) 596-1281
Mailing address
1900 10TH AVE, STE 120, COLUMBUS, GA 31901-3600
(706) 323-6914
(706) 596-1281
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
000674
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005155891
—
GA
Enumeration date
08/01/2006
Last updated
08/14/2008
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