Individual ProviderAlan R ClarkPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address4601 W Market St, Greensboro, NC 27408(336) 547-9091(336) 402-6301PECOS EnrollmentBased on the most recent information from CMS, provider Alan R Clark does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:21 AM.Profile DetailsProvider ID1619026119Provider TypeIndividualFull NameClark, Alan RTitleMr.CredentialPA-CGenderMaleSole ProprietorYesEnumeration Date1/10/2007Last Updated3/15/2012Contact InformationPractice LocationPractice Address4601 W Market St, Greensboro, NC 27408Phone(336) 547-9091Fax(336) 547-9092Mailing LocationMailing Address4149 Corbin Rd, Greensboro, NC 27405-2918Phone(336) 402-6301FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense103660North Carolina