Individual
DR. ERICA ROUSSEAU CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
225 E WOOD ST, SPARTANBURG, SC 29303-3050
(864) 560-4420
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4772
SC
2086S0129X
Vascular Surgery Physician
Primary
4772
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
047728
—
SC
05
—
Q027415
—
TN
01
—
SCG3103365
MEDICARE PIN
SC
01
—
SCG3105019
MEDICARE PIN
SC
01
—
SCG3109225
MEDICARE PIN
SC
Enumeration date
01/04/2011
Last updated
12/10/2020
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