Individual
TAMMY ANNA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
763 GATEWOOD RD NE, ATLANTA, GA 30329-4203
(404) 908-0668
Mailing address
763 GATEWOOD RD NE, ATLANTA, GA 30329-4203
(404) 908-0668
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024166030
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699867127
—
VA
Enumeration date
09/29/2006
Last updated
03/09/2022
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