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REBECCA A CLARK P.A.

>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1922067859

Individual Registrant:
 REBECCA A CLARK P.A.
Gender: F
Not Sole Proprietor

Location and contact information for practice:
664 N MAIN ST  PEARSON, GA 31642 US
Tel: 912-422-3131  Fax: 912-422-3180

Contact information for business:
406 W 5TH ST  OCILLA, GA 31774-1421 US
Tel: 229-468-9166  Fax: 229-468-9188

Registration Information:
NPI: 1922067859
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
GA001270

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
100000746BGA05




HEALTH CARE JOBS GA - Page 1



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