Individual
AMBER CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12182 HIGHWAY 92, WOODSTOCK, GA 30188-4885
(770) 516-4719
Mailing address
2759 NORTHGATE CT NW, ACWORTH, GA 30101-6898
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT003176
GA
207W00000X
Ophthalmology Physician
OPT003176
GA
Other
Enumeration date
07/10/2019
Last updated
07/10/2019
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