Active NPI
Charles Thomas Clark, D.O.
- Pediatrics Physician
- Athens, OH
National Provider Identifier
1568434397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 34--003631
- Practice address
- 313 Parks Hall
Athens, OH 45701 - Phone
- (740) 593-2444
- Fax
- (740) 593-0905
- NPI assigned
- Feb 6, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 34--003631 | OH | Primary |
Addresses
Primary practice location
313 Parks Hall
Athens, OH 45701
Mailing address
313 Parks Hall
Athens, OH 45701
Phone (740) 593-2444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0542158 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34--003631 | OH | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Athens Medical Associates, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Athens, OH
- NPI 1982714358
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785628800000",
"number": "1568434397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "313 PARKS HALL",
"city": "ATHENS",
"state": "OH",
"postal_code": "45701",
"telephone_number": "740-593-2444",
"fax_number": "740-593-0905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "313 PARKS HALL",
"city": "ATHENS",
"state": "OH",
"postal_code": "45701",
"telephone_number": "740-593-2444",
"fax_number": "740-593-0905"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CHARLES",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-06",
"last_updated": "2026-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "34--003631",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0542158",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Athens, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.