Individual
JEANINE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
175 MEDICAL BLVD, STOCKBRIDGE, GA 30281-5083
(239) 443-8018
Mailing address
17 HAMPTON ST STE F, MCDONOUGH, GA 30253-3159
(239) 443-8018
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN243362
GA
Other
Enumeration date
05/21/2018
Last updated
08/20/2024
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