Active NPI
Rebecca A Clark, P.A.
- Physician Assistant
- Pearson, GA
National Provider Identifier
1922067859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 001270
- Practice address
- 664 N Main St
Pearson, GA 31642 - Phone
- (912) 422-3131
- Fax
- (912) 422-3180
- NPI assigned
- Mar 20, 2006
- Last updated
- Nov 3, 2014
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 001270 | GA | Primary |
Addresses
Primary practice location
664 N Main St
Pearson, GA 31642
Mailing address
406 W 5TH St
Ocilla, GA 31774-1421
Phone (229) 468-9166
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100000746B | Medicaid | GA |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001270 | GA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Appalachian Home Health Care, Inc. | Current | Accepting new patients | |
| South Central Primary Care Center, Inc | Past | Accepting new patients | |
| Thomas R. Mann, M.D.PC | Past | Accepting new patients | |
| Robert a Ludwick, M.D.PC | Past | Accepting new patients |
Interoperability endpoints
- rebecca.clark@ahcs.gadirect.net
Organizations & group practices 4
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.
-
- Home Health Agency
- Blairsville, GA
- NPI 1922299817
-
- Family Medicine Physician
- Fitzgerald, GA
- NPI 1538284278
-
dba Kids Health
- Federally Qualified Health Center (FQHC)
- Douglas, GA
- NPI 1063840296
-
- Internal Medicine Physician
- Fitzgerald, GA
- NPI 1275658783
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414972800000",
"number": "1922067859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "406 W 5TH ST",
"city": "OCILLA",
"state": "GA",
"postal_code": "317741421",
"telephone_number": "229-468-9166",
"fax_number": "229-468-9188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "664 N MAIN ST",
"city": "PEARSON",
"state": "GA",
"postal_code": "31642",
"telephone_number": "912-422-3131",
"fax_number": "912-422-3180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "REBECCA",
"middle_name": "A",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-20",
"last_updated": "2014-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "001270",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100000746B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pearson, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.