Provider Demographics
NPI:1881303188
Name:CLARK, ZAVIER F
Entity type:Individual
Prefix:
First Name:ZAVIER
Middle Name:F
Last Name:CLARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 MOTTL RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-1599
Mailing Address - Country:US
Mailing Address - Phone:678-768-3627
Mailing Address - Fax:
Practice Address - Street 1:8708 MOTTL RESERVE DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-1599
Practice Address - Country:US
Practice Address - Phone:678-768-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1881303188Medicaid