Provider Demographics
NPI:1346769114
Name:DR. CLARK THOMAS, PC
Entity Type:Organization
Organization Name:DR. CLARK THOMAS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALDANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-879-6150
Mailing Address - Street 1:721 MONTCLAIR RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1905
Mailing Address - Country:US
Mailing Address - Phone:205-879-6150
Mailing Address - Fax:205-380-3406
Practice Address - Street 1:721 MONTCLAIR RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1905
Practice Address - Country:US
Practice Address - Phone:205-879-6150
Practice Address - Fax:205-380-3406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5122261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental