Individual
KORAH ELIZABETH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
72 CRAFTWAY DR, HAWKINSVILLE, GA 31036-5813
(478) 230-2453
Mailing address
72 CRAFTWAY DR, HAWKINSVILLE, GA 31036-5813
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GU4NUL
AMERICAN RED CROSS
—
Enumeration date
10/29/2018
Last updated
10/29/2018
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