Tracey Amanda Clark-Johnson

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN171140 Issued in GA

Practice address

5354 Reynolds St Ste 411
Savannah, GA 31405-6011

Phone

(912) 355-2800

Fax

(912) 355-9444

NPI assigned

Jul 19, 2022

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

Medicare enrollment (NPD)

Enrolled

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.

• Curtis V. Cooper Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
  • NPI 1750314183
  Medicare reassignment NPD
• Curtis V. Cooper Primary Health Care Inc.

  • Federally Qualified Health Center (FQHC)
  • Springfield, GA
  • NPI 1023804150
  NPD
• Curtis V. Cooper Primary Health Care Inc.

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
  • NPI 1841683067
  NPD
• Curtis V. Cooper Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
  • NPI 1659668010
  NPD
• Curtis V. Cooper Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
  • NPI 1316972599
  NPD (past)

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

{
    "created_epoch": "1658188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1770218356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 E BROAD ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314012917",
            "telephone_number": "912-527-1000",
            "fax_number": "912-527-1155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5354 REYNOLDS ST STE 411",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314056011",
            "telephone_number": "912-355-2800",
            "fax_number": "912-355-9444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK-JOHNSON",
        "first_name": "TRACEY",
        "middle_name": "AMANDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-19",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN171140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kacey Civitella
• CJ Transportation Service LLC
• Stephen F Clack, PT,DPT
• Clarafaith Home Health
• Clark Chiropractic and Wellness Care, LLC
• Alexandra Nicole Clark
• Carly Virginia Clark
• Eric B Clark Jr., DC,CCMA
• Jarlexia Clark, RBT
• Lisa Landers Clark, LPC

• Family Nurse Practitioner in Savannah, GA
• Providers in Savannah, 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 Jul 19, 2022; 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.