Provider Demographics
NPI:1740382340
Name:CLARK, VELERIA KAY
Entity Type:Individual
Prefix:MS
First Name:VELERIA
Middle Name:KAY
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VELERIA
Other - Middle Name:KAY
Other - Last Name:MCFALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5288 HOPEWELL LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-9592
Mailing Address - Country:US
Mailing Address - Phone:678-450-0210
Mailing Address - Fax:678-450-0210
Practice Address - Street 1:5288 HOPEWELL LN
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30507-9592
Practice Address - Country:US
Practice Address - Phone:678-450-0210
Practice Address - Fax:678-450-0210
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered372600000XNursing Service Related ProvidersAdult Companion
Not Answered374U00000XNursing Service Related ProvidersHome Health Aide
Not Answered376J00000XNursing Service Related ProvidersHomemaker