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:
Health care specialties
| Specialty | Code | License # | 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 3 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 | 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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