Individual
DR. CANDACE RENEE CLOCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2100 WILBORN AVE, SOUTH BOSTON, VA 24592-1628
(434) 517-8022
(434) 517-8370
Mailing address
2100 WILBORN AVE, SOUTH BOSTON, VA 24592-1628
(434) 517-8022
(434) 517-8370
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101261852
VA
208000000X
Pediatrics Physician
2013-01833
NC
261QP2300X
Primary Care Clinic/Center
33110
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33110
LICENSE NUMBER
SC
Enumeration date
10/12/2007
Last updated
03/07/2024
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