Individual
MRS. JAYNE STAFFORD CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1547 PARKWAY, GREENWOOD, SC 29646-4081
(864) 229-7120
Mailing address
49 SMITH ST, WARE SHOALS, SC 29692-1526
(706) 830-0499
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
421504
—
SC
Enumeration date
04/26/2013
Last updated
04/26/2013
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