Individual
MRS. CARLA BETH CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD, RN
Contact information
Practice address
610 SPARTA RD, SANDERSVILLE, GA 31082-1860
(478) 240-2181
(478) 240-2020
Mailing address
PO BOX 636, SANDERSVILLE, GA 31082-0636
(478) 240-2181
(478) 240-2020
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD002458
GA
163W00000X
Registered Nurse
RN207257
GA
Other
Enumeration date
08/11/2011
Last updated
08/11/2011
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