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Organization

GEORGIA DEVELOPMENTAL CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LILLEE CLARK PH.D. (PSYCHOLOGIST)
(770) 538-4800
Entity
Organization

Contact information

Practice address
615 GREEN ST NW, SUITE 201, GAINESVILLE, GA 30501-3378
(770) 538-4800
(770) 503-9299
Mailing address
615 GREEN ST NW, SUITE 201, GAINESVILLE, GA 30501-3378
(770) 538-4800
(770) 503-9299

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY001290
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00566354A
GA
Enumeration date
01/08/2007
Last updated
09/12/2007
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