Clark, Jeffrey G
Clark, Jeffrey G is an individual health care provider with primary practice located at 425 Highway 51 N , Brookhaven MS 39601-2350. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Clark, Jeffrey G can be contacted via phone (601) 833-5713.Contact Information
Primary practice address
425 Highway 51 N
Brookhaven MS 39601-2350
Phone: (601) 833-5713
Fax: (601) 833-1616
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Urology | 208800000X | 13241 | Mississippi |
Profile Details
| NPI number | 1376643247 |
|---|---|
| LBN Legal business name | Clark, Jeffrey G |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 22nd, 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 | 1376643247 | NPPES |
| Mississippi | MEDICAID | 00116404 |
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