Individual
ELIZABETH CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
295 BROADMEADOW CV, ROSWELL, GA 30075-2950
(770) 993-7918
Mailing address
295 BROADMEADOW CV, ROSWELL, GA 30075-2950
(770) 993-7918
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
24915
GA
Other
Enumeration date
12/15/2015
Last updated
12/15/2015
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