| Doctor Name: | MS. DENISE VERNALL CLARK |
| NPI Number: | 1194991349 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | EMT |
| License Number: | 35838 |
| Business Practice Address: | 258 S Thomas Street Elberton, GA - 30635 |
| Business Phone Number: | 7062835837 |
| Business Fax Number: | 7062835837 |
| Mailing Address: | 258 S Thomas Street, ELBERTON |
| State: | GA |
| Postal Code: | 30635 |
| Phone Number: | 7062835837 |
| Fax Number: | 7062835837 |
| NPI Enumeration Date: | 05/07/2008 |
| NPI Last Update Date: | 05/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 146M00000X |
| License Number: | 35838 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Emergency Medical Service Providers |
| Taxonomy Classification: | Emergency Medical Technician, Intermediate |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An Intermediate EMT is an individual trained and certified to perform intermediate life support treatment in medical emergencies based on individual state boards. |