Individual
TIMOTHY L CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 382-7120
Mailing address
PO BOX 2650, TIFTON, GA 31793-2650
(229) 353-3422
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
104963
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2022
Last updated
07/03/2025
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