Healthcare Provider Details

I. General information

NPI: 1154997146
Provider Name (Legal Business Name): ASHLEY ELIZABETH CLARKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date: 03/24/2023
Reactivation Date: 12/11/2023

III. Provider practice location address

945 82ND PKWY
MYRTLE BEACH SC
29572-4610
US

IV. Provider business mailing address

PO BOX 3439
NORTH MYRTLE BEACH SC
29582-0439
US

V. Phone/Fax

Practice location:
  • Phone: 843-497-5929
  • Fax:
Mailing address:
  • Phone: 843-497-5929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number96971
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: