NPIMap

Organization Active NPI

J Madison Clark MD PLLC

  • Otolaryngology Physician
  • Burlington, NC
National Provider Identifier
1043620347
Registry record updated Jul 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
9700217 Issued in NC
Legal business name
J MADISON CLARK MD PLLC
Practice address
1248 Huffman Mill Rd
Suite 201
Burlington, NC 27215-8700
Phone
(336) 538-1966
Fax
(336) 538-1729
NPI assigned
May 7, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sonja D Thompson
Title
Practice Administrator
Phone
(336) 538-1966

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Y00000X 9700217 NC Primary
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207YX0007X 9700217 NC

Addresses

Primary practice location

1248 Huffman Mill Rd
Suite 201
Burlington, NC 27215-8700

Mailing address

PO Box 24848
Winston Salem, NC 27114-4848
Phone (336) 538-1966

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406073600000",
    "number": "1043620347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24848",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271144848",
            "telephone_number": "336-538-1966",
            "fax_number": "336-538-1729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1248 HUFFMAN MILL RD",
            "address_2": "SUITE 201",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272158700",
            "telephone_number": "336-538-1966",
            "fax_number": "336-538-1729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J MADISON CLARK MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-07",
        "last_updated": "2014-07-23",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "SONJA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "336-538-1966"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "NC",
            "license": "9700217",
            "primary": true
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "NC",
            "license": "9700217",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.