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General NPI Number Information
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NPI Number | 1417885583
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Entity Type | Organization
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Legal Business Name | CLARK PEDIATRIC MEDICINE LLC
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Dates
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Enumeration Date | 05/11/2026
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Last Update Date | 05/11/2026
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Provider Practice Location Address
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Address Line | 1530 N FANT ST STE C1
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City | ANDERSON
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State | SC
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Zip | 29621-4700
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Country | US
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Telephone | 864-559-8464
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Fax |
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Provider Business Mailing Address
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Address Line | 119 KILSPRINGS RD
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City | ANDERSON
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State | SC
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Zip | 29621-4224
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Country | US
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Telephone | 864-387-0016
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SARA CLARK
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Credential | MD
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Telephone | 864-387-0016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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