Organization
BULL ST. DISTRICT FAMILY PRACTICE LLC
Active
Other names
Bull St District Family Practice, Cornell M. Clark, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CORNELL MAURICE CLARK M.D. (MANAGING DIRECTOR)
(702) 904-4077
Entity
Organization
Contact information
Practice address
1417 GREGG ST, COLUMBIA, SC 29201-3527
(803) 915-0469
Mailing address
PO BOX 99, COLUMBIA, SC 29202-0099
(803) 915-0469
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
—
Other
Enumeration date
03/18/2025
Last updated
03/18/2025
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