Individual
CAROLINE SHAFFNER CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2001 RANDOLPH RD, CHARLOTTE, NC 28207-1215
(704) 323-2000
Mailing address
4601 PARK RD STE 300, CHARLOTTE, NC 28209-2290
(704) 323-2000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-07961
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0397730004
NSC #
NC
05
—
2293PA
—
SC
01
—
2355
MEDICAL LICENSE #
SC
Enumeration date
07/16/2015
Last updated
04/18/2018
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