Individual
EDWARD K CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
744 1ST ST, MACON, GA 31201-6840
(478) 633-7600
(478) 633-7354
Mailing address
744 1ST ST, MACON, GA 31201-6840
(478) 633-7600
(478) 633-7354
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036700
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000672361C
—
GA
Enumeration date
02/28/2006
Last updated
05/21/2013
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