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General NPI Number Information
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NPI Number | 1922288224
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Entity Type | Organization
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Legal Business Name | TOREY B. CLARK, MD PC
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 500 W LANIER AVE SUITE 406
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7636
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Country | US
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Telephone | 678-817-5355
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Fax | 678-817-5339
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Provider Business Mailing Address
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Address Line | 500 W LANIER AVE SUITE 406
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7636
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Country | US
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Telephone | 678-817-5355
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Fax | 678-817-5339
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. TOREY B CLARK
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Credential | MD
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Telephone | 678-817-5355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036943
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License Number State | GA
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