Individual
CALLIE BIBB CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP, FNP-C
Contact information
Practice address
2258 WRIGHTSBORO RD STE 400, AUGUSTA, GA 30904-4788
(706) 724-4400
(706) 724-6003
Mailing address
PO BOX 925, AUGUSTA, GA 30903-0925
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
254429
GA
363L00000X
Nurse Practitioner
Primary
NP000357
GA
Other
Enumeration date
07/30/2021
Last updated
10/25/2021
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