Individual
MRS. DEBORAH ANN CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
347TH MEDICAL GROUP, 3278 MITCHELL BLVD, MOODY A F B, GA 31699-0001
(229) 257-5877
Mailing address
RR 1 BOX 98-38, LAKELAND, GA 31635-8706
(229) 503-9501
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0000005672
TN
Other
Enumeration date
11/30/2005
Last updated
07/08/2007
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