Individual
JONATHAN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14049 SCENIC HWY, LOOKOUT MOUNTAIN, GA 30750-4100
(706) 419-1523
Mailing address
922 FEDERAL ST, CHATTANOOGA, TN 37405-2931
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT0000001292
TN
2255A2300X
Athletic Trainer
Primary
AT001654
GA
Other
Enumeration date
11/18/2014
Last updated
11/18/2014
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