Individual
REBECCA A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
664 N MAIN ST, PEARSON, GA 31642
(912) 422-3131
(912) 422-3180
Mailing address
406 W 5TH ST, OCILLA, GA 31774-1421
(229) 468-9166
(229) 468-9188
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001270
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000746B
—
GA
Enumeration date
03/20/2006
Last updated
11/03/2014
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