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General NPI Number Information
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NPI Number | 1124592514
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Entity Type | Individual
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Provider Name | CAMERON TAYLOR CLARY
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Gender | Male
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 650 CLINIC DRIVE
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City | MOBILE
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State | AL
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Zip | 36608
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Country | US
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Telephone | 251-445-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 407 SILVER LN
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City | GREENSBORO
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State | AL
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Zip | 36744-5245
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Country | US
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Telephone | 334-507-8264
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | S12354
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License Number State | AL
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