NPIMap

Organization Active NPI

M Clark Colvard Jr MD PC

  • Specialist
  • Fort Oglethorpe, GA
National Provider Identifier
1487812517
Registry record updated Jul 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
16957 Issued in TN
Legal business name
M CLARK COLVARD JR MD PC
Practice address
102 Gross Crescent Cir
Suite 300
Fort Oglethorpe, GA 30742-3670
Phone
(706) 861-1726
Fax
(706) 861-2224
NPI assigned
May 27, 2008
Last updated
Jul 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2008

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

Authorized official

Name
M Clark Colvard Jr., MD
Title
Owner
Phone
(423) 495-4939

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 16957 TN Primary

Addresses

Primary practice location

102 Gross Crescent Cir
Suite 300
Fort Oglethorpe, GA 30742-3670

Mailing address

102 Gross Crescent Cir
Suite 300
Fort Oglethorpe, GA 30742-3670
Phone (706) 861-1726

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1211846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217203200000",
    "number": "1487812517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 GROSS CRESCENT CIR",
            "address_2": "SUITE 300",
            "city": "FORT OGLETHORPE",
            "state": "GA",
            "postal_code": "307423670",
            "telephone_number": "706-861-1726",
            "fax_number": "706-861-2224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 GROSS CRESCENT CIR",
            "address_2": "SUITE 300",
            "city": "FORT OGLETHORPE",
            "state": "GA",
            "postal_code": "307423670",
            "telephone_number": "706-861-1726",
            "fax_number": "706-861-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M CLARK COLVARD JR MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-27",
        "last_updated": "2008-07-28",
        "status": "A",
        "authorized_official_last_name": "COLVARD",
        "authorized_official_first_name": "M CLARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-495-4939",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TN",
            "license": "16957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Oglethorpe, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; 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.