Individual
MRS. MATTIE MAE FARMER CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CST/CSFA
Contact information
Practice address
PIEDMONT FAYETTE HOSPITAL, 1255 HIGHWAY 54 WEST, FAYETTEVILLE, GA 30214
(770) 719-7000
Mailing address
91 COVINGTON TER, NEWNAN, GA 30263-5771
(386) 295-3122
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
11/05/2018
Last updated
11/05/2018
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