Individual
NICOLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
710 CENTER ST, COLUMBUS, GA 31901-1527
(706) 660-2952
Mailing address
4148 WILL RHOADES DR, COLUMBUS, GA 31909-3965
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN313313
GA
Other
Enumeration date
11/14/2023
Last updated
11/14/2023
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