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General NPI Number Information
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NPI Number | 1285038869
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Entity Type | Organization
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Legal Business Name | ATWOOD AND CLARK, LLC
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Dates
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Enumeration Date | 10/10/2014
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Last Update Date | 10/10/2014
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Provider Practice Location Address
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Address Line | 6303 SUNSET AVE
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32408-3528
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Country | US
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Telephone | 724-971-7152
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Fax | 330-773-3698
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Provider Business Mailing Address
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Address Line | 6303 SUNSET AVE
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32408-3528
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Country | US
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Telephone | 724-971-7152
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Fax | 330-773-3698
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RAUN D SKYRM
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Credential |
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Telephone | 330-773-3544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME108352
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License Number State | FL
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