Active NPI
Tammy Anna Clark, CRNA
- Certified Registered Nurse Anesthetist
- Atlanta, GA
National Provider Identifier
1699867127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 0024166030
- Practice address
- 763 Gatewood Rd NE
Atlanta, GA 30329-4203 - Phone
- (404) 908-0668
- NPI assigned
- Sep 29, 2006
- 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 |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 0024166030 | VA | Primary |
Addresses
Primary practice location
763 Gatewood Rd NE
Atlanta, GA 30329-4203
Mailing address
763 Gatewood Rd NE
Atlanta, GA 30329-4203
Phone (404) 908-0668
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699867127 | Medicaid | VA |
Other names 1
- Tammy Anna Clarke
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
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0024166030 | VA | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646784000000",
"number": "1699867127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "763 GATEWOOD RD NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303294203",
"telephone_number": "404-908-0668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "763 GATEWOOD RD NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303294203",
"telephone_number": "404-908-0668"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TAMMY",
"middle_name": "ANNA",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-29",
"last_updated": "2022-03-09",
"certification_date": "2022-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "VA",
"license": "0024166030",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1699867127",
"state": "VA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TAMMY",
"last_name": "CLARKE",
"middle_name": "ANNA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.