Clark EMS Ambulance Service

Primary specialty

ParamedicTaxonomy code 146L00000X

License

11006 Issued in GA

Legal business name

CLARK EMS AMBULANCE SERVICE

Doing business as

Clark Ambulance Service

Practice address

117A Commerce Dr
Dallas, GA 30132

Phone

(770) 445-2151

Fax

(770) 943-2855

NPI assigned

Oct 5, 2006

Last updated

Feb 1, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Samuel T Clark, OWNER

Title

President

Phone

(770) 445-5008

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Clark Ambulance Service Doing business as

Locations

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359676800000",
    "number": "1952498776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1789",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "30132",
            "telephone_number": "770-445-5008",
            "fax_number": "770-943-2855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117A COMMERCE DR",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "30132",
            "telephone_number": "770-445-2151",
            "fax_number": "770-943-2855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK EMS AMBULANCE SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2013-02-01",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-445-5008",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "146L00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Paramedic",
            "state": "GA",
            "license": "11006",
            "primary": true
        },
        {
            "code": "146M00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Intermediate",
            "state": "GA",
            "license": "11006",
            "primary": false
        },
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "GA",
            "license": "11006",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00311165A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590014898",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clark Ambulance Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shania Chung
• Chary Roberta Church, LPC
• Cincourt PC
• Kristen Clackum, OT
• Clark Ambulance Service, Inc.
• Caroline Clark
• Sara Johnson Clark, M.ED.
• Camarine Clarke, LPN
• Lyndsay Claroni, DO
• Climb Chiropractic

• Paramedic in Dallas, GA
• Providers in Dallas, GA by specialty
• Paramedic in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.