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General NPI Number Information
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NPI Number | 1861566838
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Entity Type | Organization
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Legal Business Name | AUGUSTA CARDIOLOGY CLINIC, PC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 818 SAINT SEBASTIAN WAY STE 311
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City | AUGUSTA
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State | GA
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Zip | 30901-2653
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Country | US
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Telephone | 706-724-3473
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Fax | 706-724-3493
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Provider Business Mailing Address
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Address Line | 818 SAINT SEBASTIAN WAY STE 311
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City | AUGUSTA
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State | GA
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Zip | 30901-2653
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Country | US
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Telephone | 706-724-3473
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Fax | 706-724-3493
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Authorized Official
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Title or Position | OFFICER
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Name | DR. DAVID M CLARK II
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Credential | MD
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Telephone | 706-724-3473
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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 |
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License Number State |
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