MEDICARE: ATWOOD AND CLARK, LLC

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
1	208D00000X	General Practice Physician	ME108352	FL

General Provider Information

NPI Number	:	1285038869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATWOOD AND CLARK, LLC

Provider Business Mailing Address
First Line	:	6303 SUNSET AVE
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-3528
Country	:	US
Telephone Number	:	724-971-7152
Fax Number	:	330-773-3698

Provider Business Practice Location Address
First Line	:	6303 SUNSET AVE
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-3528
Country	:	US
Telephone Number	:	724-971-7152
Fax Number	:	330-773-3698

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. RAUN D SKYRM
Credential	:
Telephone Number	:	330-773-3544

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	10/10/2014

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