Individual
DOUGLAS MARLEY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
2317 S ROANE ST, COMMUNITY CARE WALK IN CLINIC, HARRIMAN, TN 37748-8653
(865) 590-0072
(865) 590-0069
Mailing address
2317 S ROANE ST, HARRIMAN, TN 37748-8653
(865) 590-0072
(865) 590-0069
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA000000019
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3723702
—
TN
Enumeration date
06/29/2006
Last updated
02/15/2012
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