Provider Demographics
NPI:1851670095
Name:CLARK DOBSON, LAUREN (DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CLARK DOBSON
Suffix:
Gender:F
Credentials:DPT
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 75
Mailing Address - Street 2:
Mailing Address - City:BONLEE
Mailing Address - State:NC
Mailing Address - Zip Code:27213-0075
Mailing Address - Country:US
Mailing Address - Phone:706-621-8908
Mailing Address - Fax:
Practice Address - Street 1:553 RIVERSTONE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5222
Practice Address - Country:US
Practice Address - Phone:770-345-3057
Practice Address - Fax:770-345-3154
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist