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General NPI Number Information
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NPI Number | 1780644252
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Entity Type | Individual
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Provider Name | M CLARK COLVARD JR. MD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 4632 BATTLEFIELD PKWY
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City | RINGGOLD
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State | GA
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Zip | 30736-8004
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Country | US
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Telephone | 706-806-0170
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Fax |
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Provider Business Mailing Address
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Address Line | 1604 GUNBARREL RD
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City | CHATTANOOGA
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State | TN
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Zip | 37421-3125
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Country | US
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Telephone | 423-648-2395
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Fax | 423-648-7542
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 028388
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License Number State | GA
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