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CLARK MEDICAL GROUP LLC NPI 1477927192


NPI Information

NPI: 1477927192
Provider Name: CLARK MEDICAL GROUP, LLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 11D2107683

Address:
117 HILL POND LN
STATESBORO, GA
ZIP 30458
Phone: (912) 623-2155
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CLARK MEDICAL GROUP, LLC is a family medicine in Statesboro, GA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. CLARK MEDICAL GROUP, LLC NPI is 1477927192. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

117 HILL POND LN
STATESBORO, GA
ZIP 30458-872
Phone: (912) 623-2155
Fax: (912) 623-2156

The provider's authorized official is Aaron Clark .
The authorized official title is Owner and has the following contact phone number (912) 623-2155.

The CLIA number assigned to this NPI record is 11D2107683 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/18/2015 and was last updated on 7/20/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine66012GEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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