Individual
CAROLINE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
80 SEVEN HILLS BLVD, SUITE 105, DALLAS, GA 30132-0574
(678) 402-0515
(678) 909-0673
Mailing address
PO BOX 441146, KENNESAW, GA 30160-9522
(678) 459-3745
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT012747
GA
Other
Enumeration date
01/27/2017
Last updated
01/27/2017
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