Individual
DEMETRIA GODFREY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4600 FORT JACKSON BLVD APT 124, COLUMBIA, SC 29209-1142
(803) 357-2268
(803) 887-5093
Mailing address
4600 FORT JACKSON BLVD APT 124, COLUMBIA, SC 29209-1142
(803) 238-9659
(893) 887-5093
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
BL002252-09-2023
SC
Other
Enumeration date
10/03/2023
Last updated
10/03/2023
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