Individual
PAMELA R. CLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
703 KINGS RDG, MONROE, GA 30655-2051
(770) 207-5788
(770) 207-5708
Mailing address
1500 LAUNIUS RD, GOOD HOPE, GA 30641-2637
(706) 752-0779
(706) 752-1596
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
001415
GA
Other
Enumeration date
12/22/2006
Last updated
07/08/2007
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