Individual
MRS. CLARICE DEWITT MARTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
300 W HOSPITAL ROAD, EISENHOWER ARMY MEDICAL CENTER ATTN CREDENTIALS, FORT GORDON, GA 30905-5650
(706) 787-2720
(706) 787-8176
Mailing address
300 W HOSPITAL ROAD, EISENHOWER ARMY MEDICAL CENTER ATTN CREDENTIALS, FORT GORDON, GA 30905-5650
(706) 787-2720
(706) 787-8176
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
GA 799
GA
Other
Enumeration date
04/29/2008
Last updated
04/29/2008
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