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Individual
JUSTIN PHILIP CLACK
Active
Individual
JUSTIN PHILIP CLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
6639
GA
207X00000X
Orthopaedic Surgery Physician
6639
GA
207XX0801X
Orthopaedic Trauma Physician
6639
GA
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
10/16/2012
Last updated
03/29/2024
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