Torey B Clark, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

036943 Issued in GA

Practice address

500 W Lanier Ave
Suite 406
Fayetteville, GA 30214-7636

Phone

(678) 817-5355

Fax

(678) 817-5339

NPI assigned

Aug 22, 2005

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: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Harbor Grace Hospice, Inc.

  • Community Based Hospice Care Agency
  • Fayetteville, GA
  • NPI 1205960473

  5% Or Greater Direct Ownership Interest, Corporate Director

  CMS ownership

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.

• Harbor Grace Hospice, Inc.

  • Community Based Hospice Care Agency
  • Fayetteville, GA
  • NPI 1205960473
  NPD

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282608000000",
    "number": "1396737680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W LANIER AVE",
            "address_2": "SUITE 406",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147636",
            "telephone_number": "678-817-5355",
            "fax_number": "678-817-5339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W LANIER AVE",
            "address_2": "SUITE 406",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147636",
            "telephone_number": "678-817-5355",
            "fax_number": "678-817-5339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TOREY",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-22",
        "last_updated": "2010-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "036943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aniya Clark, RBT
• Darsha Darlene Clark, LPC
• Erica Clark, LPC
• Jenise Trannell Clark, LPC
• Telisha Niketia Clark
• Shannon Claxton
• Jonathan Clayton, MD
• Robert L Clemons II, LPC
• Iris Branch Cleveland, LCSW
• Lisa Clevleland, RN

• Specialist in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.