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General NPI Number Information
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NPI Number | 1285838268
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Entity Type | Individual
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Provider Name | WALTER LEE CLERK CFA
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Gender | Male
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 1755 HIGHWAY 34 E STE 1100
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City | NEWNAN
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State | GA
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Zip | 30265-3184
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Country | US
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Telephone | 770-252-7510
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 71117
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City | NEWNAN
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State | GA
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Zip | 30271-1117
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Country | US
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Telephone | 770-254-1807
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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