Krystal Clark

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW008048 Issued in GA

Practice address

917 Parker Rd
Ellijay, GA 30536-7957

Phone

(678) 357-7224

NPI assigned

May 26, 2022

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

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lifesource of North CarolinaGroup PAC ID 7416132428, 172 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lifesource of North Carolina

  • General Practice Physician
  • Rome, GA
  • NPI 1962940817

  Clinical

  Medicare reassignment Care Compare group NPD
• Lifesource of North Carolina

  • Psychologist
  • Milton, FL
  • NPI 1730648288

  Clinical

  NPD

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

{
    "created_epoch": "1653523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653523200000",
    "number": "1346988441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "917 PARKER RD",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305367957",
            "telephone_number": "678-357-7224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 PARKER RD",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305367957",
            "telephone_number": "678-357-7224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KRYSTAL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-26",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW008048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larry P Bryant, PT
• Exie Ruth Buffington, LPC
• Jeannette Burgess
• Sarah M Burnett, M.S., R.D., L,D.
• Ardin Parker Lingle Chastain, LCSW
• Ronald Craig Clark, D.C., PH.D.
• Melonie Clemmons, O.D.
• Sandy Anderson Coleman
• Ivy Hope Colwell, BCBA
• Comprehensive Hospitalist of Georgia LLC

• Clinical Social Worker in Ellijay, GA
• Providers in Ellijay, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.