Individual
COLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
103 S COURT ST, 103 SOUTH STREET, CLEVELAND, MS 38732-2651
(662) 719-8217
(662) 843-0002
Mailing address
PO BOX 264, 103 SOUTH STREET, CLEVELAND, MS 38732-0264
(662) 719-8217
(662) 843-0002
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
—
MS
Other
Enumeration date
04/20/2015
Last updated
04/20/2015
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