| NPI | 1134198104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA KAY CLARK Office Manager 912-871-6206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: GA RN069911 NP) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2020-08-22 |