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General NPI Number Information
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NPI Number | 1164479762
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Entity Type | Organization
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Legal Business Name | A. KENT CLARK
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 841 UNION ST STE A
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City | SHELBYVILLE
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State | TN
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Zip | 37160-2610
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Country | US
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Telephone | 931-685-4777
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Fax | 931-685-4090
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Provider Business Mailing Address
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Address Line | 841 UNION ST STE A
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City | SHELBYVILLE
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State | TN
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Zip | 37160-2610
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Country | US
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Telephone | 931-685-4777
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Fax | 931-685-4090
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Authorized Official
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Title or Position | OWNER
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Name | ARTHUR KENT CLARK
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Credential | MD
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Telephone | 931-685-4777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 27339
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License Number State | TN
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