Individual
DR. MICHAEL DEAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5669 PEACHTREE DUNWOODY RD NE, SUITE 100, ATLANTA, GA 30342-1786
(404) 256-0404
(404) 847-0423
Mailing address
1838 AMERICAN WAY, LAWRENCEVILLE, GA 30043-6611
(770) 995-7622
(770) 995-7854
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
022527
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00239368K
—
GA
Enumeration date
03/28/2006
Last updated
08/23/2011
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