Individual
MRS. MICHELLE KING CLARDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
900 TOWNE LAKE PKWY, STE 404, WOODSTOCK, GA 30189-1602
(770) 926-9229
(678) 415-2164
Mailing address
900 TOWNE LAKE PKWY, STE 404, WOODSTOCK, GA 30189-1602
(770) 926-9229
(678) 415-2164
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001631
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003151291F
—
GA
05
—
003151291H
—
GA
Enumeration date
04/24/2007
Last updated
02/01/2017
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