Individual
COTENNA D. CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
57 EXECUTIVE PARK SOUTH NE, ATLANTA, GA 30329-2288
(404) 712-6929
(404) 712-0278
Mailing address
1857 CAMEO CT, TUCKER, GA 30084-7002
(678) 485-1156
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
RN231376
GA
363LG0600X
Gerontology Nurse Practitioner
Primary
RN231376
GA
Other
Enumeration date
09/14/2020
Last updated
12/11/2025
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