Individual
STEPHANIE IRENE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
415 N JACKSON ST, AMERICUS, GA 31709-3015
(229) 931-2470
Mailing address
1471 TY TY SPARKS RD, TIFTON, GA 31793-6342
(229) 942-3122
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN185331
GA
Other
Enumeration date
07/06/2015
Last updated
07/06/2015
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