Active NPI
John Douglas Clark Jr., MD
- Family Medicine Physician
- Brevard, NC
National Provider Identifier
1245890672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 94-01153
- Practice address
- 54 Meadowbrook Cir
Brevard, NC 28712-8543 - Phone
- (828) 553-7860
- NPI assigned
- Jun 18, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 94-01153 | NC | Primary |
Addresses
Primary practice location
54 Meadowbrook Cir
Brevard, NC 28712-8543
Mailing address
54 Meadowbrook Cir
Brevard, NC 28712-8543
Phone (828) 553-7860
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 94-01153 | NC | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560816000000",
"number": "1245890672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "54 MEADOWBROOK CIR",
"city": "BREVARD",
"state": "NC",
"postal_code": "287128543",
"telephone_number": "828-553-7860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "54 MEADOWBROOK CIR",
"city": "BREVARD",
"state": "NC",
"postal_code": "287128543",
"telephone_number": "828-553-7860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JOHN",
"middle_name": "DOUGLAS",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-06-18",
"last_updated": "2019-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NC",
"license": "94-01153",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brevard, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.