Individual
DR. TIMOTHY ADAM CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
304 SHORTER AVE NW, SUITE 201, ROME, GA 30165-4290
(706) 509-3334
(706) 509-4272
Mailing address
304 SHORTER AVE NW, SUITE 201, ROME, GA 30165-4290
(706) 509-3334
(706) 509-4272
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
69566
GA
207Q00000X
Family Medicine Physician
69566
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003134531A
—
GA
05
—
003134531B
—
GA
05
—
003134531C
—
GA
05
—
003134531D
—
GA
05
—
003134531E
—
GA
05
—
003134531F
—
GA
Enumeration date
05/23/2011
Last updated
11/03/2014
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