Provider Demographics
NPI:1154381002
Name:CLARK, JAMES A (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:CLARK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-8930
Mailing Address - Fax:423-254-5217
Practice Address - Street 1:311 CONGRESS PKWY N STE 800
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-1697
Practice Address - Country:US
Practice Address - Phone:423-744-0890
Practice Address - Fax:423-744-0849
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJQA010116225100000X
TN8822225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist