Individual
JACK C CLARK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3601 THE VANDERBILT CLINIC, NASHVILLE, TN 37232-3039
(615) 322-3000
Mailing address
719 THOMPSON LN STE 30330, NASHVILLE, TN 37204-4701
(615) 322-3000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23938
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080064805
RR MEDICARE
TN
05
—
3826588
—
TN
Enumeration date
06/15/2006
Last updated
01/08/2021
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