Individual
TERESA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ST
Contact information
Practice address
2304 W GORDON AVE APT 218, ALBANY, GA 31707-4607
(229) 395-8561
Mailing address
2304 W GORDON AVE APT 218, ALBANY, GA 31707-4607
(229) 395-8561
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
09/23/2016
Last updated
09/23/2016
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