# MRS. GRACE CLARK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1780030734
- **Gender:** F
- **Credential:** AGPCNP-B

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | RN 243044 | GA | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | RN243044 | GA | — |

## Other

- **Enumeration date:** 05/09/2016
- **Last updated:** 01/03/2019