Individual
JENNIFER LEE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1005 BOULDER DR, GRAY, GA 31032
(478) 621-2100
(478) 744-0481
Mailing address
1005 BOULDER DR, GRAY, GA 31032-6141
(478) 621-2100
(478) 744-0481
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN173733
GA
Other
Enumeration date
07/14/2009
Last updated
07/17/2019
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