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

Sex

Female

Sole proprietor

No

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.

• St Mary'S Medical Group, Inc

  • Cardiovascular Disease Physician
  • Athens, GA
  • NPI 1376711333

  GA

  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

  Hospital

  Care Compare affiliation
• St. Mary'S Good Samaritan Hospital, Inc.

  • Critical Access Hospital
  • Greensboro, GA
  • NPI 1346209137

  Hospital

  Care Compare affiliation
• St. Mary'S Hospital, Inc.

  • General Acute Care Hospital
  • Athens, GA
  • NPI 1871556621

  Hospital

  Care Compare affiliation
• St. Mary'S Sacred Heart Hospital, Inc.

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

  Hospital

  Care Compare affiliation

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. 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 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

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

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

• Olivia Clark Other name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 4, 2026.

{
    "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

• All providers in Athens, GA
• 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.