Individual
GEORGIA CLARK-ALBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS RD LD CDE
Contact information
Practice address
900 BROADWAY, BLDG 1, BANGOR, ME 04401-1900
(207) 907-1187
(207) 907-1189
Mailing address
PO BOX 934, BANGOR, ME 04402-0934
(207) 907-1187
(207) 907-1189
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI426
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
710000822
RAILROAD MEDICARE PROGRAM
ME
Enumeration date
01/14/2010
Last updated
07/28/2010
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