Brandy Lee Clark, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

163349 Issued in GA

Practice address

1575 Chattanooga Ave Ste 1
Dalton, GA 30720-2672

Phone

(706) 876-2130

NPI assigned

Dec 10, 2019

Sex

Female

Sole proprietor

Yes

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

State licenses

Practice roles

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.

• White's Pediatrics

  • Pediatrics Physician
  • Dalton, GA
  • NPI 1104005594

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1575936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575936000000",
    "number": "1669019600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 CHATTANOOGA AVE STE 1",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202672",
            "telephone_number": "706-876-2130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 CHATTANOOGA AVE STE 1",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202672",
            "telephone_number": "706-876-2130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BRANDY",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-10",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "163349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Asit Chopra
• Victoria Louise Christmas, APRN, PMHNP-BC
• Billy Dai-Sung Chung, DDS
• John Y Chung, MD
• John Clayton Church, MD
• Crystal Lynn Clark, MS, ATC
• Janae Alise Clark, APRN
• Jane S. Clark
• Jasmine Clark
• Jennifer Kathleen Clark, LCSW

• Family Nurse Practitioner in Dalton, GA
• Providers in Dalton, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; 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.