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General NPI Number Information
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NPI Number | 1144289349
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Entity Type | Individual
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Provider Name | ROBERT BICKNELL CLARK JR. M.D.,F.A.C.S.
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Gender | Male
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 1811 MANNING DR
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City | VIDALIA
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State | GA
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Zip | 30474-8921
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Country | US
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Telephone | 912-537-6344
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Fax | 912-537-1901
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Provider Business Mailing Address
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Address Line | 1811 MANNING DR
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City | VIDALIA
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State | GA
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Zip | 30474-8921
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Country | US
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Telephone | 912-537-6344
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Fax | 912-537-1901
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 020521
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License Number State | GA
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