Individual
AMANDA VICK CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5660
(601) 984-6870
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5660
(601) 984-6870
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
24985
MS
Other
Enumeration date
04/26/2010
Last updated
03/17/2018
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