Mary Olivia Clark, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

8057 Issued in GA

Practice address

2142 W Broad St, BLDG 100, Ste 200
Athens, GA 30606-3509

Phone

(706) 548-6881

Fax

(706) 546-0821

NPI assigned

Aug 3, 2016

Last updated

Mar 4, 2026By the provider in NPPES

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

Other names 1

• Olivia Clark Other name

Electronic endpoints 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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. Mary's Medical Group, Inc.Group PAC ID 7113098393, 118 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Mary's Hospital Hospital, Athens, GA, CCN 110006
• Piedmont Athens Regional Medical Center Hospital, Athens, GA, CCN 110074
• St Marys Good Samaritan Hospital Hospital, Greensboro, GA, CCN 111329
• Ty Cobb Regional Medical Center, LLC Hospital, Lavonia, GA, CCN 110027

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/7598/brand/1/csg/1/fhir/r4
• Direct secure messaging: mclark2022119@direct.trinity-health.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St Mary's Medical Group, Inc

  • Cardiovascular Disease Physician
  • Athens, GA
  • NPI 1376711333
  Medicare reassignment Care Compare group NPD (past)
• St. Mary's Medical Group, Inc.

  • Family Medicine Physician
  • Bogart, GA
  • NPI 1285116210
  NPD
• St. Mary's Medical Group, Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Athens, GA
  • NPI 1316733355
  NPD
• St. Mary's Medical Group, Inc.

  • Neurological Surgery Physician
  • Athens, GA
  • NPI 1083189591
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Piedmont Athens Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Athens, GA
  • NPI 1437186111
  Care Compare affiliation
• St. Mary's Good Samaritan Hospital, Inc.

  dba St. Mary's Good Samaritan Hospital

  • Critical Access Hospital
  • Greensboro, GA
  • NPI 1346209137
  Care Compare affiliation
• St. Mary's Hospital, Inc.

  dba St. Mary's Hospital

  • General Acute Care Hospital
  • Athens, GA
  • NPI 1871556621
  Care Compare affiliation
• St. Mary's Sacred Heart Hospital, Inc.

  • Rural Acute Care Hospital
  • Lavonia, GA
  • NPI 1518354778
  Care Compare affiliation

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

{
    "created_epoch": "1470182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772582400000",
    "number": "1821541152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 48089",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306048089",
            "telephone_number": "706-389-3740",
            "fax_number": "706-389-3951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2142 W BROAD ST, BLDG 100, STE 200",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306063509",
            "telephone_number": "706-548-6881",
            "fax_number": "706-546-0821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARY",
        "middle_name": "OLIVIA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-03",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "8057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "OLIVIA",
            "last_name": "CLARK",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Justin Philip Clack, PA
• Claire N. Zimmerman, LLC
• Alyssa G Clark, PH.D.
• Jessica Lane Clark, PMHNP
• Latarious Clark
• Michelle Randall Clark, LCSW
• Rachel Clark, LPC, NCC
• Clarke County Board-Health
• Clarke County Department of Health
• Clarke County Department of Health (Specialty Care Clinic)

• Medical Physician Assistant in Athens, GA
• Providers in Athens, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2026; 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.