Individual
JESSICA LANE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
745 S MILLEDGE AVE STE 1A, ATHENS, GA 30605-1292
(706) 498-9560
(706) 498-9568
Mailing address
745 S MILLEDGE AVE STE 1A, ATHENS, GA 30605-1292
(706) 498-9560
(706) 498-9568
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN222359
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN-NP222359
GA
Other
Enumeration date
07/13/2021
Last updated
02/09/2026
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