Healthcare Provider Details

I. General information

NPI: 1417885583
Provider Name (Legal Business Name): CLARK PEDIATRIC MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 N FANT ST STE C1
ANDERSON SC
29621-4700
US

IV. Provider business mailing address

119 KILSPRINGS RD
ANDERSON SC
29621-4224
US

V. Phone/Fax

Practice location:
  • Phone: 864-559-8464
  • Fax:
Mailing address:
  • Phone: 864-387-0016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SARA CLARK
Title or Position: OWNER
Credential: MD
Phone: 864-387-0016