Individual
MARY OLIVIA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2142 W BROAD ST, BLDG 100, STE 200, ATHENS, GA 30606-3509
(706) 548-6881
(706) 546-0821
Mailing address
PO BOX 48089, ATHENS, GA 30604-8089
(706) 389-3740
(706) 389-3951
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
8057
GA
Other
Enumeration date
08/03/2016
Last updated
03/04/2026
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