Healthcare Provider Details

I. General information

NPI: 1689588758
Provider Name (Legal Business Name): DENNIS DEWAYNE CLARK, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 TOWN CENTER DR STE 100
ANNISTON AL
36205-4102
US

IV. Provider business mailing address

171 TOWN CENTER DR STE 100
ANNISTON AL
36205-4102
US

V. Phone/Fax

Practice location:
  • Phone: 256-237-1624
  • Fax: 256-241-2277
Mailing address:
  • Phone: 256-237-1624
  • Fax: 256-241-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DENNIS DEWAYNE CLARK
Title or Position: OWNER
Credential: MD
Phone: 256-237-1624