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Contact Information

THERESA C CLARK, REGISTERED NURSE
1900 CARRIAGE DR
PHENIX CITY, AL36867-2116
 Phone: 706-289-9327
 Fax: 888-547-2536
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Registered Nurse

163W00000X
Indicates primary specialty

NPI Profile & details for THERESA C CLARK · (Female)

NPI # 1003056383
Status Active
Credentials REGISTERED NURSE
Entity Individual
Enumeration date 02/26/2009
Last updated 02/26/2009 - About 17 years ago
Sole proprietor 1 Yes
Identifiers
  • GA License # 166504
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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