Active NPI
Eric Clark
- Social Worker
- Columbia, SC
National Provider Identifier
1043777204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 12799
- Practice address
- 2711 Colonial Dr
Columbia, SC 29203-6818 - Phone
- (803) 726-9300
- NPI assigned
- Feb 25, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 12799 | SC | Primary |
Addresses
Primary practice location
2711 Colonial Dr
Columbia, SC 29203-6818
Mailing address
2711 Colonial Dr
Columbia, SC 29203-6818
Phone (803) 726-9300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12799 | SC | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551052800000",
"number": "1043777204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2711 COLONIAL DR",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292036818",
"telephone_number": "803-726-9300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2711 COLONIAL DR",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292036818",
"telephone_number": "803-726-9300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ERIC",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-02-25",
"last_updated": "2019-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "SC",
"license": "12799",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.