Active NPI
Monica E Clark, C.N.M.
- Midwife
- Marietta, GA
National Provider Identifier
1316998719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Midwife
- License
- RN0963644
- Practice address
- 72 Plaza Way NW
Marietta, GA 30060-1104 - Phone
- (770) 422-8700
- Fax
- (700) 425-7601
- NPI assigned
- May 12, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Midwife | 176B00000X | RN0963644 | GA | Primary |
Addresses
Primary practice location
72 Plaza Way NW
Marietta, GA 30060-1104
Mailing address
72 Plaza Way NW
Marietta, GA 30060-1104
Phone (770) 422-8700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 1, 2016 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN0963644 | GA | MD | Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257120000000",
"number": "1316998719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "72 PLAZA WAY NW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300601104",
"telephone_number": "770-422-8700",
"fax_number": "700-425-7601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "72 PLAZA WAY NW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300601104",
"telephone_number": "770-422-8700",
"fax_number": "700-425-7601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "MONICA",
"middle_name": "E",
"credential": "C.N.M.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-12",
"last_updated": "2009-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": "GA",
"license": "RN0963644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.