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NPI Code Detail

MEDICARE: MICHAEL SCOTT CLARK M.D.

MEDICARE: MICHAEL SCOTT CLARK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry Physician35611NC
22084P0800XPsychiatry Physician35611NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184785701
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL SCOTT CLARK M.D.
Provider Business Mailing Address
First Line : 2102 ROLLING RD
Second Line :
City : GREENSBORO
State : NC
Zip : 27403-1535
Country : US
Telephone Number : 336-378-9425
Fax Number :
Provider Business Practice Location Address
First Line : 13815 PROFESSIONAL CENTER DR STE 100
Second Line :
City : HUNTERSVILLE
State : NC
Zip : 28078-7951
Country : US
Telephone Number : 704-384-1320
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 10/27/2020

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