ROBERT B CLARK JR MD LLC NPI 1326079039

NPI Information

  • NPI: 1326079039
  • Provider Name: ROBERT B CLARK JR MD LLC
  • Classification: Specialist - 174400000X
  • Entity Type: Organization
  • Address: 1811 MANNING DRIVE
    VIDALIA, GA
    ZIP 30474
  • Phone: (912) 537-6634

Map and Directions

Get Directions

NPI Details

ROBERT B CLARK JR MD LLC is a specialist in Vidalia, GA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. ROBERT B CLARK JR MD LLC NPI is 1326079039. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1811 MANNING DRIVE
VIDALIA, GA
ZIP 30474
Phone: (912) 537-6634
Fax: (912) 537-1909

The provider's authorized official is Priscilla E Edge .
The authorized official title is Credentialing and has the following contact phone number (912) 537-8691.

The enumeration date for this NPI number is 7/5/2006 and was last updated on 3/27/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialist020521GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1GRP7739OTHERGEORGIAMEDICARE GROUP NUMBER
2449866340OTHERGEORGIAMEDICAID REFERRAL
3000177713DMEDICAIDGEORGIA
41144289349OTHERGUAMPERSONAL NPI NUMBER 1144289349

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI