Healthcare Provider Details

I. General information

NPI: 1114986023
Provider Name (Legal Business Name): NANCY S CLARK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 MEDICAL PARK DR
HARTSVILLE SC
29550-4765
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 843-383-2764
  • Fax: 844-689-5206
Mailing address:
  • Phone: 502-588-0325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number96463
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number50539
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: