Individual
WINSTON CRAIG CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
704 S BROAD ST, THOMASVILLE, GA 31792-6107
(229) 584-5760
(229) 584-5945
Mailing address
704 S BROAD ST, THOMASVILLE, GA 31792-6107
(229) 584-5760
(229) 584-5945
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
35395
GA
207T00000X
Neurological Surgery Physician
MD14839
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115774
—
MS
01
—
162898
BCBST
TN
05
—
3029594
—
TN
01
—
35395
LICENSE
GA
Enumeration date
03/01/2006
Last updated
11/04/2022
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