Elliott Cline Clark, PHARMD.

Primary specialty

PharmacistTaxonomy code 183500000X

License

RPH033220 Issued in GA

Practice address

116 W Maple St
Cumming, GA 30040-2634

Phone

(770) 887-5040

Fax

(770) 887-1699

NPI assigned

Aug 25, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

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.

• Goodson Drug Co.

  • Pharmacist
  • Cumming, GA
  • NPI 1174609655
  NPD (past)

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

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629849600000",
    "number": "1992472195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 HOWELL MILL RD NW UNIT 419",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303185959",
            "telephone_number": "770-596-3777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 W MAPLE ST",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300402634",
            "telephone_number": "770-887-5040",
            "fax_number": "770-887-1699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ELLIOTT",
        "middle_name": "CLINE",
        "name_prefix": "Dr.",
        "credential": "PHARMD.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-25",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH033220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharon F Clackum, PHARM.D., CGP, FASCP
• Clarity Vision Group, LLC
• Amanda Clark, PA-C
• Carolyn Denbow Clark, OTR/L
• Christina S Clark, PHARM. D.
• Melissa Clark
• Victoria Elizabeth Clark, OTR
• Jenna Clausen-Voorhees, RBT
• Clear Life Consulting LLC
• Clear Life Counseling & Testing

• Pharmacist in Cumming, GA
• Providers in Cumming, GA by specialty
• Pharmacist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.

Verify at the official NPI Registry.