Individual
MS. THERESA CARLISLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
1900 CARRIAGE DR, PHENIX CITY, AL 36867-2116
(706) 289-9327
(888) 547-2536
Mailing address
1900 CARRIAGE DR, PHENIX CITY, AL 36867-2116
(706) 289-9327
(888) 547-2536
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
166504
GA
Other
Enumeration date
02/26/2009
Last updated
02/26/2009
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