NPIMap

Individual provider Active NPI

Aaron Taylor Clark, M.D.

  • Family Medicine Physician
  • Statesboro, GA
National Provider Identifier
1134439581
Registry record updated Jul 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
66012 Issued in GA
Practice address
117 Hill Pond LN
Statesboro, GA 30458-0872
Phone
(912) 623-2155
Fax
(912) 623-2156
NPI assigned
Oct 19, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 66012 GA Primary

Addresses

Primary practice location

117 Hill Pond LN
Statesboro, GA 30458-0872

Mailing address

117 Hill Pond LN
Statesboro, GA 30458-0872
Phone (912) 623-2155

Other identifiers 1

IdentifierTypeStateIssuer
003109717CMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110707000215 GA Practitioner - Family Practice 8325226772 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clark Medical Group LLCGroup PAC ID 8820390347, 2 clinicians
Hospital Authority of Candler CountyGroup PAC ID 5294623948, 36 clinicians

Practice addresses (Care Compare)

117 Hill Pond LN
Statesboro, GA 30458-0872
Phone (912) 623-2155

PO Box
Suite 597
Metter, GA 30439

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Statesboro, GA, CCN 117033
  • Amedisys Home Health Home health agency, Vidalia, GA, CCN 117075
  • Gentiva Hospice, Savannah, GA, CCN 111615
  • East Georgia Regional Medical Center Hospital, Statesboro, GA, CCN 110075
  • Candler County Hospital Hospital, Metter, GA, CCN 111334

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Authority of Candler County CurrentSince Feb 14, 2023 Accepting new patients
Hospital Authority of Candler County Current Accepting new patients
Hospital Authority of Candler County Family Medicine CurrentSince Feb 14, 2023 Accepting new patients
Clark Medical Group, LLC Family Medicine CurrentSince Jan 1, 2016 Accepting new patients
Hospital Authority of Candler County Family Medicine Past Accepting new patients

Locations

400 Cedar St
Metter, GA 30439
Phone (912) 685-1726

10 Doctors St
Metter, GA 30439
Phone (912) 685-5715

117 Hill Pond Ln
Statesboro, GA 30458
Phone (912) 623-2155

1550 Brampton Ave
Ste B
Statesboro, GA 30458
Phone (912) 623-2155

Interoperability endpoints

  • Direct secure messaging: clarkmedicalgroup.aaronclark@132499.advancedmd-direct.com
  • Direct secure messaging: aaron.clark.1@23328.direct.athenahealth.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1287446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595203200000",
    "number": "1134439581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 HILL POND LN",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580872",
            "telephone_number": "912-623-2155",
            "fax_number": "912-623-2156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 HILL POND LN",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580872",
            "telephone_number": "912-623-2155",
            "fax_number": "912-623-2156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "AARON",
        "middle_name": "TAYLOR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-19",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "66012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003109717C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesboro, GA

Sources for this page

Verify at the official NPI Registry.