Clark, Mark D

Clark, Mark D is an individual health care provider with primary practice located at 102 Barrett St , Gainesville GA 30501-1356. He recently has 4 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Gerontology, Physician Assistants & Advanced Practice Nursing Providers / Acute Care. Physician Assistants & Advanced Practice Nursing Providers / Acute Care is his primary health care specialty. Clark, Mark D can be contacted via phone (770) 540-4274.

Contact Information

Primary practice address
102 Barrett St Gainesville GA 30501-1356
Phone: (770) 540-4274
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X RN128712 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X RN128712 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X RN128712 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X RN128712 Georgia

Profile Details

NPI number 1285631887
LBN Legal business name Clark, Mark D
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 29th, 2005
Last updated Feb 5th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285631887 NPPES
Georgia Other 1738523 WELLCARE
Georgia Other 06423272 WELLCARE
Georgia MEDICAID 615230572C WELLCARE
Georgia MEDICAID 615230572E WELLCARE
Georgia MEDICAID 615230572F WELLCARE
Georgia MEDICAID 615230572D WELLCARE

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