Individual
DR. ROBERT MILTON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1701 MAGNOLIA WAY STE 101, AUGUSTA, GA 30909-9484
(706) 922-6600
(706) 650-0239
Mailing address
PO BOX 2510, EVANS, GA 30809-2510
(706) 922-8251
(706) 922-6695
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
040887
GA
207Q00000X
Family Medicine Physician
Primary
40887
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00680061A
—
GA
01
—
040887
LICENSE
GA
01
—
10057091
AMERIGROUP
GA
01
—
336952
WELLCARE
GA
01
—
424
LICENSE
SC
01
—
CH0654
RR MEDICARE GROUP PIN
GA
05
—
G25973
—
SC
Enumeration date
07/05/2006
Last updated
04/17/2026
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