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General NPI Number Information
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NPI Number | 1164692711
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Entity Type | Individual
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Provider Name | MELANIE HELENE CLARK MD
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Gender | Female
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 4354A OLD SHELL RD # 324
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City | MOBILE
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State | AL
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Zip | 36608-2011
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Country | US
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Telephone | 251-622-8489
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Fax |
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Provider Business Mailing Address
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Address Line | 22 COUNTRY CLUB RD
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City | MOBILE
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State | AL
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Zip | 36608-2302
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Country | US
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Telephone | 251-622-8489
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101243188
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 30361
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD203822
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License Number State | OR
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