Individual
SANDRA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RT(R)
Contact information
Practice address
139 COUNTY ROAD 379, WATER VALLEY, MS 38965-3607
(662) 514-5215
Mailing address
139 COUNTY ROAD 379, WATER VALLEY, MS 38965-3607
(662) 514-5215
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
Primary
MRT2279
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09851011
—
MS
Enumeration date
03/05/2007
Last updated
07/09/2007
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