Individual
MR. CHARLES PATRICK CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
120 RIVERVIEW ST, FRANKLIN, NC 28744
(828) 524-8411
Mailing address
1084 THOMPSON RD, FRANKLIN, NC 28734
(828) 369-9187
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
151205
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8052336
—
NC
05
—
986074426A
—
GA
01
—
P00289782
RAILROAD MEDICARE
NC
Enumeration date
07/20/2006
Last updated
07/09/2009
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