Organization
EN BONNE SANTE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANINE CLARK DNP (NURSE PRACTITIONER)
(239) 443-8018
Entity
Organization
Contact information
Practice address
17 HAMPTON ST STE F, MCDONOUGH, GA 30253-3159
(239) 443-8018
Mailing address
17 HAMPTON ST STE F, MCDONOUGH, GA 30253-3159
(239) 443-8018
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/20/2024
Last updated
09/26/2024
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