Princess Clark, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN128145 Issued in GA

Practice address

3905 Brookside Pkwy Ste 300
Alpharetta, GA 30022-4458

Phone

(770) 442-1911

Fax

(770) 442-0306

NPI assigned

Sep 23, 2017

Sex

Female

Sole proprietor

No

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

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeast Medical Group, P.C.Group PAC ID 3577559673, 139 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DIJIBA

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.

• Southeast Medical Group, P.C.

  dba North Atlanta Primary Care, P.C.

  • Family Medicine Physician
  • Alpharetta, GA
  • NPI 1235296054
  Medicare reassignment Care Compare group NPD
• Utm of Georgia Physicians LLC

  • Family Medicine Physician
  • Fort Oglethorpe, GA
  • NPI 1255893038
  Medicare reassignment NPD
• Hamilton Physician Group Inc

  • Cardiovascular Disease Physician
  • Dalton, GA
  • NPI 1235455569
  NPD (past)
• Physician First Health Network

  • Public Health or Welfare Agency
  • Alpharetta, GA
  • NPI 1598558181
  NPD (past)

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

{
    "created_epoch": "1506124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1679082549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80883",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306080883",
            "telephone_number": "706-549-8114",
            "fax_number": "404-384-6807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3905 BROOKSIDE PKWY STE 300",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300224458",
            "telephone_number": "770-442-1911",
            "fax_number": "770-442-0306"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "76 Highland Pavilion Ct Ste 133",
            "address_purpose": "LOCATION",
            "city": "Hiram",
            "state": "GA",
            "postal_code": "301413170",
            "country_code": "US",
            "telephone_number": "770-439-1172",
            "fax_number": "706-378-1204",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18 Riverbend Dr SW Ste 120",
            "address_purpose": "LOCATION",
            "city": "Rome",
            "state": "GA",
            "postal_code": "301616019",
            "country_code": "US",
            "telephone_number": "706-378-1202",
            "fax_number": "706-378-1204",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1503 Professional Ct",
            "address_purpose": "LOCATION",
            "city": "Dalton",
            "state": "GA",
            "postal_code": "30720",
            "country_code": "US",
            "telephone_number": "706-281-2121",
            "fax_number": "706-378-1204",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1504 N Thornton Ave Ste 107",
            "address_purpose": "LOCATION",
            "city": "Dalton",
            "state": "GA",
            "postal_code": "307208394",
            "country_code": "US",
            "telephone_number": "706-278-0138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "PRINCESS",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-23",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN128145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alison Clark
• Edward Clark, LPC., CCADC
• Elizabeth Larson Clark
• Kyle Clark, DPT
• Michele R Clark, LMFT
• Rachel Clark
• Vashti M Clark
• Kiara Clarke
• Clarkson Optometry Georgia Inc (Clarkson Eyecare)
• Linda A Clarkson, LPC

• Family Nurse Practitioner in Alpharetta, GA
• Providers in Alpharetta, 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 May 10, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.