| Doctor Name: | MRS. DEBORAH ANN CLARK |
| NPI Number: | 1245214733 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 0000005672 |
| Business Practice Address: | 347th Medical Group 3278 Mitchell Blvd Moody A F B, GA - 316990001 |
| Business Phone Number: | 2292575877 |
| Business Fax Number: | |
| Mailing Address: | Rr 1 Box 98-38, LAKELAND |
| State: | GA |
| Postal Code: | 316358706 |
| Phone Number: | 2295039501 |
| Fax Number: | |
| NPI Enumeration Date: | 11/30/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 0000005672 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |