Individual
JALITA LAUREN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2100 COMER AVE, COLUMBUS, GA 31904-8725
(706) 596-5583
Mailing address
127 TWELVE OAKS DR, LAGRANGE, GA 30241-9647
(912) 614-8555
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN070344
GA
Other
Enumeration date
01/27/2015
Last updated
01/27/2015
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