Bull St. District Family Practice LLC

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

Legal business name

BULL ST. DISTRICT FAMILY PRACTICE LLC

Doing business as

Bull St District Family Practice
Cornell M. Clark, M.D.

Practice address

1417 Gregg St
Columbia, SC 29201-3527

Phone

(803) 915-0469

NPI assigned

Mar 18, 2025

Last updated

Mar 18, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Cornell Maurice Clark, M.D.NPI 1700990421

Title

Managing Director

Phone

(702) 904-4077

Specialties & licenses 1

Addresses

Other names 2

• Bull St District Family Practice Doing business as
• Cornell M. Clark, M.D. Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Cornell M Clark, M.D.

  • Family Medicine Physician
  • Las Vegas, NV
  • NPI 1700990421
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1742256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742256000000",
    "number": "1265232326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292020099",
            "telephone_number": "803-915-0469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 GREGG ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292013527",
            "telephone_number": "803-915-0469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BULL ST. DISTRICT FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-18",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CORNELL",
        "authorized_official_middle_name": "MAURICE",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "702-904-4077",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bull St District Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cornell M. Clark, M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tatiana Bufton, PHARMD
• Shannon Bui, MD
• Nicole Buie, LMSW
• Building Resilience Counseling & Wellness, LLC
• Charity Marie Bukowski, CRNA
• Aurora Bull
• Amber Auten Bullard, APRN
• John Leland Bullard Jr., MD
• Michelle Buller, APRN
• Cyra Bullock

• Adult Medicine Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Adult Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.