Individual
MARSHALL B CLACK, II II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1075 S MAIN ST, ST 100, MADISON, GA 30650-2033
(706) 752-0322
Mailing address
2323 FIELDSTONE DR SE, CONYERS, GA 30013-1918
(770) 710-3598
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
11/23/2013
Last updated
11/23/2013
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