Provider Demographics
NPI:1215222021
Name:CLARK, DYANNA GEFFEL (MD)
Entity type:Individual
Prefix:DR
First Name:DYANNA
Middle Name:GEFFEL
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DYANNA
Other - Middle Name:LEIGH
Other - Last Name:GEFFEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:719 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7014
Mailing Address - Country:US
Mailing Address - Phone:336-378-1110
Mailing Address - Fax:336-378-9986
Practice Address - Street 1:719 GREEN VALLEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7014
Practice Address - Country:US
Practice Address - Phone:336-378-1110
Practice Address - Fax:336-378-9986
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208635207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology