MEDICARE: DR. BARRY LEE CLARK D.O.

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	207X00000X	Orthopaedic Surgery Physician	833	SC
2	207X00000X	Orthopaedic Surgery Physician	26229	MS
3	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	26229	MS

Other Identifiers

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

General Provider Information

NPI Number	:	1891795985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY LEE CLARK D.O.

Provider Business Mailing Address
First Line	:	499 GLOSTER CREEK VLG STE G1
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-4751
Country	:	US
Telephone Number	:	662-377-2663
Fax Number	:	662-377-6706

Provider Business Practice Location Address
First Line	:	700 MEDICAL PARK DR
Second Line	:
City	:	HARTSVILLE
State	:	SC
Zip	:	29550-4765
Country	:	US
Telephone Number	:	843-383-3742
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	10/30/2020

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Directions to “ DR. BARRY LEE CLARK D.O.” Practice Location

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