Individual
DENNIS DEWAYNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 TOWN CENTER DR, ANNISTON, AL 36205-4101
(256) 237-1624
(256) 238-0555
Mailing address
PO BOX 5430, ANNISTON, AL 36205-0430
(256) 237-1624
(256) 238-0555
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
23397
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000097064
—
AL
01
—
020048856
UNITED HEALTHCARE
AL
01
—
51097064
BLUE CROSS BLUE SHIELD
AL
Enumeration date
02/07/2006
Last updated
07/28/2011
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