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General NPI Number Information
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NPI Number | 1982608428
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Entity Type | Individual
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Provider Name | JAMES WARNER CLARK MD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 105 LIMESTONE RURITAN RD
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City | LIMESTONE
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State | TN
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Zip | 37681-2515
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Country | US
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Telephone | 423-257-8089
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Fax | 423-257-5179
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Provider Business Mailing Address
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Address Line | PO BOX 850
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City | ROGERSVILLE
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State | TN
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Zip | 37857-0850
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Country | US
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Telephone | 423-257-8089
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Fax | 423-257-5179
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 15468
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License Number State | TN
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