Individual
CASEY DANIEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
230 SHERATON BLVD, MACON, GA 31210-1358
(478) 474-2947
(478) 971-8149
Mailing address
230 SHERATON BLVD, MACON, GA 31210-1358
(478) 474-2947
(478) 971-8149
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN214247
GA
Other
Enumeration date
11/22/2017
Last updated
11/22/2017
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