Provider Demographics
NPI:1720512163
Name:CLARK-GARVEY, SEAN (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:CLARK-GARVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MANNING DRIVE CB# 7305
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7305
Mailing Address - Country:US
Mailing Address - Phone:919-966-1996
Mailing Address - Fax:919-966-6735
Practice Address - Street 1:170 MANNING DRIVE CB# 7305
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7305
Practice Address - Country:US
Practice Address - Phone:919-966-1996
Practice Address - Fax:919-966-6735
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC262577390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program