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General NPI Number Information
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NPI Number | 1942445309
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Entity Type | Organization
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Legal Business Name | CLARKE FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 2520 WALES AVE NW STE 220
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City | MASSILLON
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State | OH
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Zip | 44646-2310
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Country | US
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Telephone | 330-858-1566
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Fax |
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Provider Business Mailing Address
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Address Line | 2520 WALES AVE. SUITE 220
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City | MASSILLON
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State | OH
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Zip | 44646-2310
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Country | US
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Telephone | 330-858-1566
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ASHLEY WILLIAMS CLARKE
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Credential | D.O.
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Telephone | 330-834-1473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 34007798
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License Number State | OH
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