Individual
DIAZ CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
101 LEXINGTON CIR, PEACHTREE CITY, GA 30269-6845
(770) 534-6299
Mailing address
101 LEXINGTON CIR, PEACHTREE CITY, GA 30269-6845
(770) 486-1639
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN144424
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN144424
LICENSE
GA
Enumeration date
10/14/2021
Last updated
12/08/2021
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