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1720573447
JONATHAN CLARK
DECATUR, GA
NPI
1720573447
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: GA AT003189)
Enumeration Date
2018-06-25
Last Update Date
2018-06-25
Business Address
JONATHAN CLARK
1214 HIGHLAND LAKE CIR
DECATUR, GA 30033-3460
Phone number: 585-857-2586
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Mailing Address
JONATHAN CLARK
1214 HIGHLAND LAKE CIR
DECATUR, GA 30033-3460
Phone number:
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