Clark, Jerrold A
Clark, Jerrold A is an individual health care provider with primary practice located at 2275 Northwest Parkway Se Suite 140, Marietta GA 30067-9319. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Blood Banking & Transfusion Medicine, Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology. Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology is his primary health care specialty. Clark, Jerrold A can be contacted via phone (770) 951-1793.Contact Information
Primary practice address
2275 Northwest Parkway Se Suite 140
Marietta GA 30067-9319
Phone: (770) 951-1793
Fax: (770) 612-3380
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Blood Banking & Transfusion Medicine | 207ZB0001X | 026841 | Georgia |
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | 026841 | Georgia |
Profile Details
| NPI number | 1700866324 |
|---|---|
| LBN Legal business name | Clark, Jerrold A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 19th, 2006 |
| Last updated | May 29th, 2015 - about 9 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700866324 | NPPES |
| Georgia | Other | 52235375 009 | BCBS MARIETTA |
| Georgia | Other | 345972 | BCBS MARIETTA |
| Georgia | MEDICAID | 202I220225 | BCBS MARIETTA |
| Georgia | Other | 52235375 006 | BCBS MARIETTA |
| Georgia | Other | 581267100 | BCBS MARIETTA |
| Georgia | MEDICAID | 000302112A | BCBS MARIETTA |
| Georgia | Other | 52235375 008 | BCBS MARIETTA |
| Georgia | Other | 52235375 005 | BCBS MARIETTA |
| Georgia | Other | 52235375 007 | BCBS MARIETTA |
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