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Individual

DR. JAMEEL TAMIR CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4420 DIXIE HWY STE 126, LOUISVILLE, KY 40216-2994
(502) 810-3780
(502) 394-3607
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 272-5395
(502) 272-5339

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
002969
GA
208000000X
Pediatrics Physician
47695
TN
208000000X
Pediatrics Physician
Primary
TP415
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1525008
TN
Enumeration date
06/25/2008
Last updated
03/26/2021
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