Individual
MR. GREGORY GLEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
677 CHURCH ST NE, MARIETTA, GA 30060-1101
(770) 794-0477
(770) 794-3108
Mailing address
531 ROSELANE ST NW STE 830, MARIETTA, GA 30060-6979
(770) 794-0477
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001772
GA
Other
Enumeration date
01/28/2007
Last updated
07/14/2022
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