Active NPI
Charlotte Renee Clark
- Behavior Technician
- Norcross, GA
National Provider Identifier
1851967459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 4335 Steve Reynolds Blvd
Norcross, GA 30093-3362 - Phone
- (770) 822-9115
- NPI assigned
- Jun 3, 2021
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
4335 Steve Reynolds Blvd
Norcross, GA 30093-3362
Mailing address
1990 Willow Trail Pkwy
Norcross, GA 30093-2665
Phone (678) 900-6193
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | www.easterseals.com | Direct |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622678400000",
"number": "1851967459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1990 WILLOW TRAIL PKWY",
"city": "NORCROSS",
"state": "GA",
"postal_code": "300932665",
"telephone_number": "678-900-6193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4335 STEVE REYNOLDS BLVD",
"city": "NORCROSS",
"state": "GA",
"postal_code": "300933362",
"telephone_number": "770-822-9115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CHARLOTTE",
"middle_name": "RENEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-03",
"last_updated": "2021-06-03",
"certification_date": "2021-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "www.easterseals.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "4335 Steve Reynolds Blvd",
"city": "Norcross",
"state": "GA",
"country_code": "US",
"postal_code": "300933362",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Norcross, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.