Provider Demographics
NPI:1790011542
Name:CLARK, MACHELL BELL
Entity Type:Individual
Prefix:
First Name:MACHELL
Middle Name:BELL
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3011 S MEMORIAL DR
Practice Address - Street 2:SUITE 7
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6238
Practice Address - Country:US
Practice Address - Phone:252-327-3705
Practice Address - Fax:252-364-1534
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant