Provider Demographics
NPI:1316998719
Name:CLARK, MONICA E (CNM)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:E
Last Name:CLARK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 PLAZA WAY NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1104
Mailing Address - Country:US
Mailing Address - Phone:770-422-8700
Mailing Address - Fax:700-425-7601
Practice Address - Street 1:72 PLAZA WAY NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1104
Practice Address - Country:US
Practice Address - Phone:770-422-8700
Practice Address - Fax:700-425-7601
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN0963644176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife