Active NPI
George Edward Clark III, M.D.
- Pediatrics Physician
- Paris, TX
National Provider Identifier
1992733802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- E6284
- Practice address
- 3150 Clarksville St
Suite 100
Paris, TX 75460-8076 - Phone
- (903) 782-9206
- Fax
- (903) 783-7352
- NPI assigned
- Jun 29, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | E6284 | TX | Primary |
Addresses
Primary practice location
3150 Clarksville St
Suite 100
Paris, TX 75460-8076
Mailing address
3150 Clarksville St
Suite 100
Paris, TX 75460-8076
Phone (903) 782-9206
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 124603503 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E6284 | TX | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201651200000",
"number": "1992733802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3150 CLARKSVILLE ST",
"address_2": "SUITE 100",
"city": "PARIS",
"state": "TX",
"postal_code": "754608076",
"telephone_number": "903-782-9206",
"fax_number": "903-783-7352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3150 CLARKSVILLE ST",
"address_2": "SUITE 100",
"city": "PARIS",
"state": "TX",
"postal_code": "754608076",
"telephone_number": "903-782-9206",
"fax_number": "903-783-7352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "GEORGE",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-29",
"last_updated": "2008-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "E6284",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "124603503",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Paris, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.