Individual
DR. TERESA ELAINE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D. PC
Contact information
Practice address
2920 S PHARR CT NW, ATLANTA, GA 30305-2104
(404) 261-9043
(404) 581-5440
Mailing address
667 LANIER PARK DR, GAINESVILLE, GA 30501-2059
(770) 532-7501
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
020417
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00211758A
—
GA
Enumeration date
07/11/2006
Last updated
03/31/2020
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