Clark Medical Group, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

66012 Issued in GA

Legal business name

CLARK MEDICAL GROUP, LLC

Practice address

117 Hill Pond LN
Statesboro, GA 30458-0872

Phone

(912) 623-2155

Fax

(912) 623-2156

NPI assigned

Nov 18, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Aaron Clark, MDNPI 1134439581

Title

Owner

Phone

(912) 623-2155

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Aaron Taylor Clark, M.D.

  • Family Medicine Physician
  • Statesboro, GA
  • NPI 1134439581
  Medicare reassignment Care Compare group NPD Authorized official
• Iris Kalin Clark, M.D.

  • Family Medicine Physician
  • Statesboro, GA
  • NPI 1174887004
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1447804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595203200000",
    "number": "1477927192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 HILL POND LN",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580872",
            "telephone_number": "912-623-2155",
            "fax_number": "912-623-2156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 HILL POND LN",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580872",
            "telephone_number": "912-623-2155",
            "fax_number": "912-623-2156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-18",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-623-2155",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "66012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Cherrett
• Olivia Anne Chester, MOT, OTR/L
• Muchaneta Chikawa
• Ansha Childs
• Andrew Vincent Cichelli, MD
• Aaron Taylor Clark, M.D.
• Adam Wyatt Clark, PHARM.D
• Gayle Chappell Clark, R.PH
• Iris Kalin Clark, M.D.
• Michael Ryan Clark, PHARMD

• Family Medicine Physician in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.