Individual
MRS. BRANTRIESA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4181 HOSPITAL DR NE STE 205, COVINGTON, GA 30014-2541
(678) 342-8677
Mailing address
1829 LAWRENCEVILLE HWY, DECATUR, GA 30033-5728
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
8587
GA
363A00000X
Physician Assistant
Primary
8587
GA
Other
Enumeration date
10/31/2017
Last updated
06/19/2025
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