Clark, Terry Lee

Clark, Terry Lee is an individual health care provider with primary practice located at 109 Bee St , Charleston SC 29401-5703. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Clark, Terry Lee can be contacted via phone (843) 789-7330.

Contact Information

Primary practice address
109 Bee St Charleston SC 29401-5703
Phone: (843) 789-7330
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X A475 South Carolina

Profile Details

NPI number 1053310516
LBN Legal business name Clark, Terry Lee
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 18th, 2005
Last updated Feb 4th, 2008 - about 16 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 1053310516 NPPES
South Carolina MEDICAID QM0402

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