Individual
MR. EDGAR VINCENT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCC-S
Contact information
Practice address
101 HARRIS INDUSTRIAL BLVD, VIDALIA, GA 30474-8845
(912) 537-2044
(912) 277-2098
Mailing address
PO BOX 383, GLENWOOD, GA 30428-0383
(912) 568-7687
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP004577
GA
Other
Enumeration date
05/22/2007
Last updated
07/08/2007
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