Organization
GEORGIA VOLUNTEER HEALTH CARE PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PRINCESS B. CLARK FNP (FNP)
(770) 837-5656
Entity
Organization
Contact information
Practice address
6744 BROOKFIELD WAY, DOUGLASVILLE, GA 30134-1461
(770) 837-5656
Mailing address
6744 BROOKFIELD WAY, DOUGLASVILLE, GA 30134-1461
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
RN128145
GA
Other
Enumeration date
10/05/2016
Last updated
10/05/2016
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