DEPARTMENT OF INSURANCE

Name	Clark, Daisha	DOIID	1175682	NAIC NPN	20153675

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Inactive	Non Resident	Agent	Personal Lines	12/7/2021	10/2/2023

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

No License Renewal Information

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Residence	Not Public Information
Business / Home Office	768 Edenton Ct Jonesboro, GA 302384493

Phone Information

Type	Phone
Business / Home Office	(678) 683-3579