Individual
CLARK PATRICK WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1519 MARION ST, COLUMBIA, SC 29201-2910
(803) 296-5954
(803) 296-3076
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
52527
SC
2085R0202X
Diagnostic Radiology Physician
Primary
52527
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2018
Last updated
02/14/2024
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