Provider Demographics
NPI:1003017229
Name:CLARK, DANIEL JAMES (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:CLARK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:5665 NEW NORTHSIDE DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5831
Mailing Address - Country:US
Mailing Address - Phone:770-874-5400
Mailing Address - Fax:770-874-5483
Practice Address - Street 1:5330 S HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9225
Practice Address - Country:US
Practice Address - Phone:928-788-7115
Practice Address - Fax:770-874-5483
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2022-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK4708207L00000X
ARE-5858207L00000X
WAOP 60011959207L00000X
AZ4799207L00000X, 207L00000X
CA20A10260207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology