Active NPI
Gayle Chappell Clark, R.PH
- Geriatric Pharmacist
- Statesboro, GA
National Provider Identifier
1629263447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Pharmacist
- License
- 14963
- Practice address
- 10929 US Highway 301 S
Suite 111
Statesboro, GA 30458-7774 - Phone
- (912) 764-7839
- NPI assigned
- Sep 14, 2007
- 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 |
|---|---|---|---|---|
| Geriatric Pharmacist | 1835G0303X | 14963 | GA | Primary |
Addresses
Primary practice location
10929 US Highway 301 S
Suite 111
Statesboro, GA 30458-7774
Mailing address
10929 US Highway 301 S
Suite 111
Statesboro, GA 30458-7774
Phone (912) 764-7839
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)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14963 | GA | MD | Geriatric Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314489600000",
"number": "1629263447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10929 US HIGHWAY 301 S",
"address_2": "SUITE 111",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304587774",
"telephone_number": "912-764-7839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10929 US HIGHWAY 301 S",
"address_2": "SUITE 111",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304587774",
"telephone_number": "912-764-7839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "GAYLE",
"middle_name": "CHAPPELL",
"credential": "R.PH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-14",
"last_updated": "2011-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "1835G0303X",
"taxonomy_group": "",
"desc": "Pharmacist, Geriatric",
"state": "GA",
"license": "14963",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Statesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.