Edward K Clark, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036700 Issued in GA

Practice address

744 1St St
Macon, GA 31201-6840

Phone

(478) 633-7600

Fax

(478) 633-7354

NPI assigned

Feb 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Floyd Healthcare Management Inc

  • Family Medicine Physician
  • Rome, GA
  • NPI 1689610149
  Medicare reassignment NPD
• Health Services of Central Georgia, Inc

  • Multi-Specialty Clinic/Center
  • Macon, GA
  • NPI 1184679482

  Pediatrics

  Medicare reassignment NPD
• Floyd Healthcare Management Inc

  • Specialty Pharmacy
  • Rome, GA
  • NPI 1548056468
  NPD
• Central Georiga Fertility Institute

  • Reproductive Endocrinology Physician
  • Macon, GA
  • NPI 1447390901
  NPD (past)

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369094400000",
    "number": "1669448569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 1ST ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312016840",
            "telephone_number": "478-633-7600",
            "fax_number": "478-633-7354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 1ST ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312016840",
            "telephone_number": "478-633-7600",
            "fax_number": "478-633-7354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "EDWARD",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2013-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "036700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000672361C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gloria Smith Cisse, LPC, LMSW
• Citadel Health LLC
• Debra Clapp, PARAPROFESSIONAL, BA
• Clark General Dentistry Center, P.C.
• Casey Daniel Clark, NP
• Ileha M Clark
• Julie J Clark, FNP-BC
• Kameron Alexander Clark, MD
• Kiofa Enez Clark, D.C.
• Lauren Clark

• Pediatrics Physician in Macon, GA
• Providers in Macon, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.