Individual
EDNA MICHELLE CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
635 SLADE ST, HINESVILLE, GA 31313-3941
(912) 368-2107
Mailing address
635 SLADE ST, HINESVILLE, GA 31313-3941
(912) 368-2107
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN047051
GA
Other
Enumeration date
10/31/2005
Last updated
07/08/2007
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