Individual
MICHAEL A CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3950 AUSTELL RD, AUSTELL, GA 30106-1121
(770) 732-5000
Mailing address
5665 NEW NORTHSIDE DR NW, SUITE 320, ATLANTA, GA 30328-5831
(770) 874-5468
(770) 874-5469
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6072
GA
Other
Enumeration date
03/10/2011
Last updated
09/21/2022
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