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General NPI Number Information
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NPI Number | 1689588758
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Entity Type | Organization
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Legal Business Name | DENNIS DEWAYNE CLARK, MD LLC
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 171 TOWN CENTER DR STE 100
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City | ANNISTON
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State | AL
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Zip | 36205-4102
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Country | US
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Telephone | 256-237-1624
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Fax | 256-241-2277
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Provider Business Mailing Address
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Address Line | 171 TOWN CENTER DR STE 100
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City | ANNISTON
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State | AL
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Zip | 36205-4102
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Country | US
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Telephone | 256-237-1624
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Fax | 256-241-2277
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Authorized Official
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Title or Position | OWNER
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Name | DENNIS DEWAYNE CLARK
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Credential | MD
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Telephone | 256-237-1624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | NULL
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