Provider Demographics
NPI:1306820279
Name:CLARKE, DEBRA-ANN MAURITA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA-ANN
Middle Name:MAURITA
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:SUITE 1D03
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-767-4549
Mailing Address - Fax:912-767-4664
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:SUITE 1D03
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:912-767-4549
Practice Address - Fax:912-767-4664
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101237025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine