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MRS. LISA L. CLARK FNP

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1801160353

Individual Registrant:
MRS. LISA L. CLARK FNP
Gender: F
Not Sole Proprietor

Location and contact information for practice:
1005 BOULDER DR  GRAY, GA 31032 US
Tel: 478-621-2100  Fax: 478-744-0481

Contact information for business:
1005 BOULDER DR  GRAY, GA 31032-6141 US
Tel: 478-621-2100  Fax: 478-744-0481

Registration Information:
NPI: 1801160353
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
GARN089162

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
003179288AGA05




HEALTH CARE JOBS GA - Page 1



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