Provider Demographics
NPI:1740846393
Name:DR. SONYA M CLARK P.C.
Entity type:Organization
Organization Name:DR. SONYA M CLARK P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
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:864-640-8488
Practice Address - Street 1:89 W MILLS ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-9450
Practice Address - Country:US
Practice Address - Phone:864-308-8668
Practice Address - Fax:864-640-8488
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPSTATE HAND CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-18
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1336579093OtherNPI
NPIOther1427174374