Keanna L Joseph-Clarke, MD
Individual provider Active NPI Pediatrics Physician · Clarkston, GA
NPI 1962579631 · NPPES record last updated Nov 24, 2015
Key facts
- NPI
- 1962579631
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 061271 (GA)
- Practice address
- 4112 E Ponce de Leon Ave
Clarkston, GA 30021-8106 - Phone
- (404) 296-7133
- Fax
- (404) 296-7211
- NPI assigned
- Nov 29, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 061271 | GA | MD | Pediatrics Physician |
Interoperability endpoints
- keanna.joseph-clarke.1@23699.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 061271 | GA | Yes |
Addresses
Primary practice location
4112 E Ponce de Leon Ave
Clarkston, GA 30021-8106
Mailing address
4112 E Ponce de Leon Ave
Clarkston, GA 30021-8106
Phone (404) 296-7133
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 061271 | Other | GA | LICENSE |
Other providers in Clarkston, GA
- Sonni Jackson
- Sydney Jakes
- Carlton Johnson
- Ariana Sade Jones
- S'Zahria Symone Jones
- Kids-Doc-on-Wheels
- Esther Kim
- Marilyn Cecelia Kimble
- Robert Marc Kleiner
- Emily Schober Klingman
All providers in Clarkston, GA · Pediatrics Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 24, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.