Active NPI
Doren Louise Clark, NURSE PRACTITIONER
- Family Medicine Physician
- Atlanta, GA
National Provider Identifier
1407369200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- F10170170
- Practice address
- 5505 Peachtree Dunwoody Rd
Atlanta, GA 30342-1705 - Phone
- (678) 705-2118
- NPI assigned
- Nov 15, 2017
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | F10170170 | GA | Primary |
Addresses
Primary practice location
5505 Peachtree Dunwoody Rd
Atlanta, GA 30342-1705
Mailing address
4009 Andover Cir
McDonough, GA 30252-5502
Phone (404) 694-3236
Medicare participation
Medicare enrollment files- 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: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220422002039 | GA | Order and Referring Only - Nurse Practitioner | 2264829159 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F10170170 | GA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510704000000",
"number": "1407369200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4009 ANDOVER CIR",
"city": "MCDONOUGH",
"state": "GA",
"postal_code": "302525502",
"telephone_number": "404-694-3236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5505 PEACHTREE DUNWOODY RD",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303421705",
"telephone_number": "678-705-2118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "DOREN",
"middle_name": "LOUISE",
"credential": "NURSE PRACTITIONER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-15",
"last_updated": "2017-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "F10170170",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2017; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.