Individual
MICHAEL SCOTT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13815 PROFESSIONAL CENTER DR STE 100, HUNTERSVILLE, NC 28078-7951
(704) 384-1320
Mailing address
2102 ROLLING RD, GREENSBORO, NC 27403-1535
(336) 378-9425
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
35611
NC
2084P0804X
Child & Adolescent Psychiatry Physician
35611
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8922671
—
NC
Enumeration date
12/13/2006
Last updated
10/27/2020
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