NPI 1619531936

Ileha M Clark

Practitioner PACE Provider Organization Macon, GA

Practice location

Address: 152 New St STE 103m, Macon, GA 31201-7304
Phone: (478) 508-7124

Registered specialties (2)

PACE Provider Organization Primary

Agencies Taxonomy 251T00000X

Other Program of All-Inclusive Care for the Elderly (PACE) Provider Organization providers in Georgia →

Chore Provider

Nursing Service Related Providers Taxonomy 372500000X

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Registry record

NPI: 1619531936
Entity type: Individual
Sex (as registered): Female
NPI issued: 23 Apr 2019
Record last updated: 3 May 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.