Provider Demographics
NPI:1285838268
Name:CLERK, WALTER LEE (CFA)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:LEE
Last Name:CLERK
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71117
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30271-1117
Mailing Address - Country:US
Mailing Address - Phone:770-254-1807
Mailing Address - Fax:
Practice Address - Street 1:1755 HIGHWAY 34 E STE 1100
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3184
Practice Address - Country:US
Practice Address - Phone:770-252-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant