Mr Edgar Vincent Clark, CCC-S | |
101 Harris Industrial Blvd, Vidalia, GA 30474-8845 | |
(912) 537-2044 | |
(912) 277-2098 |
Full Name | Mr Edgar Vincent Clark |
---|---|
Gender | Male |
Speciality | Speech-language Pathologist |
Location | 101 Harris Industrial Blvd, Vidalia, Georgia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1962611202 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
235Z00000X | Speech-language Pathologist | SLP004577 (Georgia) | Primary |
Provider Name | Coastal Voice & Dysphagia Diagnostics, Llc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1194358150 PECOS PAC ID: 6901235803 Enrollment ID: O20200327001710 |
Mailing Address | Practice Location Address |
---|---|
Mr Edgar Vincent Clark, CCC-S Po Box 383, Glenwood, GA 30428-0383 Ph: (912) 568-7687 | Mr Edgar Vincent Clark, CCC-S 101 Harris Industrial Blvd, Vidalia, GA 30474-8845 Ph: (912) 537-2044 |
Mrs. Jill Nicole Lawrence, CCC/SLP Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 1400 Ne Main St, Bethany Alf, Vidalia, GA 30474 Phone: 912-375-3797 | |
Mrs. Margaret Fairley Wood, CCC/SLP Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 101 Harris Industrial Blvd, Vidalia, GA 30474 Phone: 912-277-2044 Fax: 912-277-2099 | |
Emily Shaw, Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 400 Adams St Unit B, Vidalia, GA 30474 Phone: 478-254-0636 Fax: 912-525-2847 | |
Melissa Williamson, M.ED/CF Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 607 Jackson St, Vidalia, GA 30474 Phone: 912-331-0846 Fax: 678-792-4894 | |
Kayla Edwards, CCC-SLP Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 303 Harris Industrial Blvd Ste 5, Vidalia, GA 30474 Phone: 912-331-0846 Fax: 678-792-4894 | |
Skye Besier, CCC-SLP Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 1500 Loop Rd, Vidalia, GA 30474 Phone: 912-537-0813 | |
Mrs. Abby Virginia Adams, M.ED., CCC-SLP Speech-Language Pathologist Medicare: Medicare Enrolled Practice Location: 101 Harris Insustrial Blvd, Vidalia, GA 30474 Phone: 912-277-2053 |