Individual
KELLEY NICHOLA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-7694
(678) 312-1000
(678) 312-3282
Mailing address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-7694
(678) 312-1000
(678) 312-3282
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
GAA-CRNA004022
GA
367500000X
Certified Registered Nurse Anesthetist
Primary
R196154
MD
Other
Enumeration date
01/06/2014
Last updated
02/23/2026
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