Provider Demographics
NPI:1780619403
Name:CLARK, GEORGE BARNES II (RN)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:BARNES
Last Name:CLARK
Suffix:II
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1545
Mailing Address - Country:US
Mailing Address - Phone:501-224-7838
Mailing Address - Fax:
Practice Address - Street 1:4301 WEST 7TH ST
Practice Address - Street 2:CODE 112LR
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-0000
Practice Address - Country:US
Practice Address - Phone:501-257-6813
Practice Address - Fax:501-257-6825
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR40850163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse