Crystal Lynn Clark, MS, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT002055 Issued in GA

Practice address

1500 Manley St
Dalton High School
Dalton, GA 30720-4088

Phone

(734) 395-9716

NPI assigned

Aug 31, 2015

Last updated

Aug 31, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1440979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440979200000",
    "number": "1467829911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 BROADRICK DR",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202504",
            "telephone_number": "734-395-9716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 MANLEY ST",
            "address_2": "DALTON HIGH SCHOOL",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307204088",
            "telephone_number": "734-395-9716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CRYSTAL",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "MS, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-31",
        "last_updated": "2015-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT002055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Louise Christmas, APRN, PMHNP-BC
• Billy Dai-Sung Chung, DDS
• John Y Chung, MD
• John Clayton Church, MD
• Brandy Lee Clark, APRN
• Janae Alise Clark, APRN
• Jane S. Clark
• Jasmine Clark
• Jennifer Kathleen Clark, LCSW
• Krista Renae Clark, M.S. CCC-SLP

• Athletic Trainer in Dalton, GA
• Providers in Dalton, GA by specialty
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2015; 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.