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General NPI Number Information
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NPI Number | 1114594389
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Entity Type | Organization
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Legal Business Name | CLARK FAMILY CARE LLC
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 715 W OGEECHEE ST
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City | SYLVANIA
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State | GA
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Zip | 30467-8693
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Country | US
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Telephone | 912-451-4100
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Fax | 912-451-4105
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Provider Business Mailing Address
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Address Line | PO BOX 194
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City | SYLVANIA
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State | GA
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Zip | 30467-0194
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Country | US
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Telephone | 912-451-4100
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Fax |
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Authorized Official
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Title or Position | FNP-C
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Name | KENDALL CLARK
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Credential | FNP-C
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Telephone | 912-451-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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