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Individual

JAIME CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
112 MIKEL CT, SUMMERVILLE, SC 29485-4806
(774) 313-0827
Mailing address
112 MIKEL CT, SUMMERVILLE, SC 29485-4806

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-14109
NC

Other

Enumeration date
12/06/2023
Last updated
09/08/2025
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