Teresa Clark, ST
Contractor in Albany, GA. Individual provider (NPI-1).
NPI number1144779778
StatusActive
Last updated in NPPESSep 23, 2016
Details
- NPI
- 1144779778
- Entity type
- Individual (NPI-1)
- Name
- Teresa Clark
- Credential
- ST
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 23, 2016
- Last updated
- Sep 23, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171W00000X | Contractor | – | – | Yes |
Practice location
2304 W Gordon Ave Apt 218Albany, GA 31707-4607
Phone 229-395-8561
Mailing address
2304 W Gordon Ave Apt 218Albany, GA 31707-4607
Phone 229-395-8561
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