Colleen Clark

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

04674 Issued in MD

Practice address

3700 Crestwood Pkwy NW Ste 500
Duluth, GA 30096-5585

Phone

(678) 924-5700

NPI assigned

Sep 16, 2006

Sex

Female

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639008000000",
    "number": "1255437208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 CRESTWOOD PKWY NW STE 500",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300965585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 CRESTWOOD PKWY NW STE 500",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300965585",
            "telephone_number": "678-924-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "COLLEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-16",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MD",
            "license": "04674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lewin Go Chuachiaco, MD
• Daniel Chung, D.D.S.
• Jennifer Chung
• Seung Goo Chung, D.C
• Tracey Civil
• Donte Clark
• Timilyn Clark, OTR
• Samantha Lee Claxton, OD
• Clayton R. Davis, D.M.D., P.C.
• Amber Clayton

• Physical Medicine & Rehabilitation Physician in Duluth, GA
• Providers in Duluth, GA by specialty
• Physical Medicine & Rehabilitation Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; 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.