Childers, Clark Edwin

Childers, Clark Edwin is an sole proprietor health care provider with primary practice located at 4607 Maccorkle Ave Sw Mp Ste 204, South Charleston WV 25309-1364. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Childers, Clark Edwin can be contacted via phone (304) 767-7930.

Contact Information

Primary practice address
4607 Maccorkle Ave Sw Mp Ste 204 South Charleston WV 25309-1364
Phone: (304) 767-7930
Fax: (304) 767-7935
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 18115 West Virginia

Profile Details

NPI number 1184793150
LBN Legal business name Childers, Clark Edwin
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 6th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184793150 NPPES
West Virginia MEDICAID 0109655000

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