Individual
JONATHAN DANIEL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
11306 COUNTY LINE RD, MADISON, AL 35756-2011
(256) 216-5313
Mailing address
925 FRANKLIN ST SE STE A, HUNTSVILLE, AL 35801-4307
(256) 265-5000
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1378
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1378
STATE OF ALABAMA BOARD OF ATHLETIC TRAINERS
AL
01
—
2000006545
BOC CERTIFIED ATHLETIC TRAINER
—
Enumeration date
08/13/2014
Last updated
08/13/2014
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