Clark, Kristen J.

Clark, Kristen J. is an individual health care provider with primary practice located at 1856-14 Thompson Bridge Rd , Gainesville GA 30501-1663. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Clark, Kristen J. can be contacted via phone (770) 534-2800.

Contact Information

Primary practice address
1856-14 Thompson Bridge Rd Gainesville GA 30501-1663
Phone: (770) 534-2800
Fax: (770) 534-2889
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 004548 Georgia

Profile Details

NPI number 1578527545
LBN Legal business name Clark, Kristen J.
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 14th, 2006
Last updated May 27th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578527545 NPPES
Georgia MEDICAID 613657510A

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