Healthcare Provider Details

I. General information

NPI: 1336579093
Provider Name (Legal Business Name): DR. SONYA M CLARK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2013
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SKYLYN DR STE 380
SPARTANBURG SC
29307-1081
US

IV. Provider business mailing address

1650 SKYLYN DR STE 380
SPARTANBURG SC
29307-1087
US

V. Phone/Fax

Practice location:
  • Phone: 864-308-8668
  • Fax: 864-640-6848
Mailing address:
  • Phone: 864-308-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SONYA MICIAK CLARK
Title or Position: ORTHOPEDIC SURGEON
Credential: D.O.
Phone: 864-308-8668