Edgar Vincent Clark, CCC-S
Individual provider Active NPI Speech-Language Pathologist · Vidalia, GA
NPI 1962611202 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1962611202
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SLP004577 (GA)
- Practice address
- 101 Harris Industrial Blvd
Vidalia, GA 30474-8845 - Phone
- (912) 537-2044
- Fax
- (912) 277-2098
- NPI assigned
- May 22, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP004577 | GA | Yes |
Addresses
Primary practice location
101 Harris Industrial Blvd
Vidalia, GA 30474-8845
Mailing address
PO Box 383
Glenwood, GA 30428-0383
Phone (912) 568-7687
Other providers in Vidalia, GA
- Chapman Healthcare Serv Inc.
- George Wesley Chapman
- Chauncy Montgomery
- Jonathan Logan Chrisian
- Amanda Claire Clark
- Robert Bicknell Clark Jr.
- Esther Harvey Clements
- Cheryl Taylor Cliff
- Kristin Clifton
- Henry D Cline
All providers in Vidalia, GA · Speech-Language Pathologist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.