Individual
WILLIAM ANDREW CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, RD
Contact information
Practice address
807 UNIVERSITY PKWY, BOX 70403, JOHNSON CITY, TN 37614-6500
(423) 439-4071
(423) 439-4060
Mailing address
807 UNIVERSITY PKWY, BOX 70403, JOHNSON CITY, TN 37614-6500
(423) 439-4071
(423) 439-4060
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LDN2487
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LDN0000002487
ST LIC
TN
Enumeration date
10/16/2012
Last updated
10/16/2012
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