Provider Demographics
NPI:1336579093
Name:DR. SONYA M CLARK P.C.
Entity Type:Organization
Organization Name:DR. SONYA M CLARK P.C.
Other - Org Name:UPSTATE HAND CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:MICIAK
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:864-308-8668
Mailing Address - Street 1:1702 SKYLYN DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1040
Mailing Address - Country:US
Mailing Address - Phone:864-308-8668
Mailing Address - Fax:
Practice Address - Street 1:1650 SKYLYN DR STE 380
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1081
Practice Address - Country:US
Practice Address - Phone:864-308-8668
Practice Address - Fax:864-640-6848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-16
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDGP9495Medicaid
SCDE3953Medicaid
SC710461001OtherDME
SC1427174374OtherNPI