Individual
TINA L CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDO2206
Contact information
Practice address
557 HIGHWAY 11, MONROE, GA 30655-6078
(678) 758-4783
Mailing address
557 HIGHWAY 11, MONROE, GA 30655-6078
(678) 758-4783
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LDO2206
GA
Other
Enumeration date
03/12/2024
Last updated
03/19/2024
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