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General NPI Number Information
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NPI Number | 1760462451
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Entity Type | Organization
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Legal Business Name | CLARK AMBULANCE SERVICE, INC.
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 117A COMMERCE DR
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City | DALLAS
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State | GA
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Zip | 30132-5025
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Country | US
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Telephone | 770-445-2151
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Fax | 770-505-7273
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Provider Business Mailing Address
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Address Line | PO BOX 1789
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City | DALLAS
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State | GA
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Zip | 30132-0031
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Country | US
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Telephone | 770-445-5008
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Fax | 770-505-7273
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MR. SAMUEL THOMAS CLARK
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Credential |
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Telephone | 770-445-5008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 110-06
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License Number State | GA
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