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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184793150 | NPPES |
| West Virginia | MEDICAID | 0109655000 |
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