David Ray Clark IV
Individual provider Active NPI In Home Supportive Care Agency · South Pittsburg, TN
NPI 1083476733 · NPPES record last updated Jan 29, 2024
Key facts
- NPI
- 1083476733
- Entity type
- Individual (NPI type 1)
- Primary specialty
- In Home Supportive Care Agency 253Z00000X
- License
- 71446 (TN)
- Practice address
- 109 6TH St
South Pittsburg, TN 37380-1331 - Phone
- (423) 838-2780
- NPI assigned
- Jan 29, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71446 | TN | MD | In Home Supportive Care Agency |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| In Home Supportive Care Agency | 253Z00000X | 71446 | TN | Yes |
Addresses
Primary practice location
109 6TH St
South Pittsburg, TN 37380-1331
Mailing address
109 6TH St
South Pittsburg, TN 37380-1331
Phone (423) 838-2780
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All providers in South Pittsburg, TN · In Home Supportive Care Agency in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.