Corbin Ross Clark

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12063 Issued in TN

Practice address

2111 Belcourt Ave Ste 201
Nashville, TN 37212-3540

Phone

(615) 322-2377

NPI assigned

Apr 25, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jun 3, 2026 through Jun 3, 2028

Medicare enrollment (NPD)

Not enrolled

Practice roles

Interoperability endpoints

• Direct secure messaging: cclark720004@direct.vumc.org

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.

• Vanderbilt University

  dba Vanderbilt Medical Group

  • Clinical Social Worker
  • Nashville, TN
  • NPI 1285659706
  NPD (past)
• Vanderbilt University Medical Center

  dba Vanderbilt Medical Group

  • Internal Medicine Physician
  • Nashville, TN
  • NPI 1104202761
  NPD (past)

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

{
    "created_epoch": "1650844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785888000000",
    "number": "1215671334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9671 WILTSHIRE DR",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373634885",
            "telephone_number": "209-769-5473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 BELCOURT AVE STE 201",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372123540",
            "telephone_number": "615-322-2377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CORBIN",
        "middle_name": "ROSS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-25",
        "last_updated": "2026-08-05",
        "certification_date": "2026-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "12063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolina Wilcox Clark, M.D., M.P.H.
• Catherine Paige Clark, RN
• Chanella Latre Clark, LPCC
• Charles Amos Clark, M.D.
• Connie Renea Clark, LPN
• Craig Anthony Clark, M.D.
• David Nelson Clark, MPT
• Eric Christopher Clark, AGACNP
• Ethan Clark
• Glenelyn Rogers Clark, LCSW

• Oral and Maxillofacial Surgery (Dentist) in Nashville, TN
• Providers in Nashville, TN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.