Organization
COVENANT FAMILY ALLERGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW T CLARK M.D. (PHYSICIAN/OWNER)
(803) 441-8648
Entity
Organization
Contact information
Practice address
616 EDGEFIELD RD, SUITE 180, NORTH AUGUSTA, SC 29841-1938
(803) 279-7666
(803) 279-0708
Mailing address
616 EDGEFIELD RD, SUITE 180, NORTH AUGUSTA, SC 29841-1938
(803) 279-7666
(803) 279-0708
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
28227
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28227
STATE MEDICAL LICENSE
SC
01
—
57156
STATE MEDICAL LICENSE
GA
Enumeration date
05/05/2008
Last updated
04/18/2013
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