Provider Demographics
NPI:1871305250
Name:CLARK, MEGAN (RD, LD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BELL CIR
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-3135
Mailing Address - Country:US
Mailing Address - Phone:205-612-2344
Mailing Address - Fax:
Practice Address - Street 1:7191 CAHABA VALLEY RD STE 108
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35242-6461
Practice Address - Country:US
Practice Address - Phone:205-930-8339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2047133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered