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General NPI Number Information
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NPI Number | 1073908034
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Entity Type | Individual
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Provider Name | MACKENZIE JAMES CLARKSON MD
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Gender | Male
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 1377 LOCUST AVE
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City | FAIRMONT
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State | WV
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Zip | 26554-1791
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Country | US
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Telephone | 304-363-3500
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Fax | 304-366-4073
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Provider Business Mailing Address
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Address Line | PO BOX 9186
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City | MORGANTOWN
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State | WV
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Zip | 26506-9186
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Country | US
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Telephone | 304-293-1224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 27820
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 27820
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License Number State | WV
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