Provider Demographics
NPI:1821227547
Name:CLARK, CRAIG (ATC)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:CLARK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FURMAN UNIVERSITY SPORTS MED
Mailing Address - Street 2:3300 POINSETT HIGHWAY
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29613-0001
Mailing Address - Country:US
Mailing Address - Phone:864-294-2000
Mailing Address - Fax:
Practice Address - Street 1:FURMAN UNIVERSITY SPORTS MED
Practice Address - Street 2:3300 POINSETT HIGHWAY
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29613-0001
Practice Address - Country:US
Practice Address - Phone:864-294-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer