Healthcare Provider Details

I. General information

NPI: 1073972964
Provider Name (Legal Business Name): JAMES CLARK & ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N BROWN ST
CHADBOURN NC
28431-1307
US

IV. Provider business mailing address

711 N BROWN ST
CHADBOURN NC
28431-1307
US

V. Phone/Fax

Practice location:
  • Phone: 910-516-2067
  • Fax: 910-516-2161
Mailing address:
  • Phone: 910-516-2067
  • Fax: 910-516-2161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7917
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9752
License Number StateNC

VIII. Authorized Official

Name: BEBE GUNTER JACKSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-863-2377