Individual
CHERRY GAY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
18199 HIGHWAY 80, HICKORY, MS 39332-0220
(601) 646-5445
(601) 646-5446
Mailing address
PO BOX 220, HICKORY, MS 39332-0220
(601) 646-5445
(601) 646-5446
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
07972
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114924
—
MS
Enumeration date
08/31/2006
Last updated
07/08/2007
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