Preston Samuel Clark Jr., MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

21016 Issued in NC

Practice address

1511 Westover Terrace
Suite 101
Greensboro, NC 27408

Phone

(336) 373-0311

Fax

(336) 373-1150

NPI assigned

Jan 11, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349827200000",
    "number": "1790835940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 WESTOVER TERRACE",
            "address_2": "SUITE 101",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "27408",
            "telephone_number": "336-373-0311",
            "fax_number": "336-373-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 WESTOVER TERRACE",
            "address_2": "SUITE 101",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "27408",
            "telephone_number": "336-373-0311",
            "fax_number": "336-373-1150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "PRESTON",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2012-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "21016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8922705",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Josie Clark, LPC
• Kayla Elizabeth Clark, OTR/L
• Kimberline Geanelle Clark, M.A., CCC-SLP
• Lakiya Clark
• Michael Lee Clark, PA-C
• Rebecca Ann Clark, OTR
• Ryonna Lanae Clark
• Sherry L. Clark, N.P.
• Timothy Clark, DC
• William D Clark, MD

• Internal Medicine Physician in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2012; 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.