Individual
EVERALD CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
133 GINKGO LN, GROVETOWN, GA 30813-5395
(706) 631-2082
Mailing address
133 GINKGO LN, GROVETOWN, GA 30813-5395
(706) 631-2082
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT007169
GA
225100000X
Physical Therapist
PT23048
FL
Other
Enumeration date
05/28/2007
Last updated
07/08/2007
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