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General NPI Number Information
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NPI Number | 1356313969
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Entity Type | Individual
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Provider Name | DENNIS DEWAYNE CLARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 07/28/2011
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Provider Practice Location Address
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Address Line | 111 TOWN CENTER DR
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City | ANNISTON
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State | AL
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Zip | 36205-4101
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Country | US
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Telephone | 256-237-1624
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Fax | 256-238-0555
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Provider Business Mailing Address
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Address Line | PO BOX 5430
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City | ANNISTON
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State | AL
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Zip | 36205-0430
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Country | US
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Telephone | 256-237-1624
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Fax | 256-238-0555
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 23397
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License Number State | AL
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