Individual
DONALD CLARK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
25138
MS
Other
Enumeration date
04/27/2010
Last updated
04/11/2019
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