Courtney A Clark, DO | |
2274 Highway 43 S, Picayune, MS 39466-8141 | |
(601) 347-9024 | |
(601) 798-5914 |
Full Name | Courtney A Clark |
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Gender | Female |
Speciality | Pediatrics |
Location | 2274 Highway 43 S, Picayune, Mississippi |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1790100113 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 1790100113 (Virginia) | Secondary |
208000000X | Pediatrics | 29407 (Mississippi) | Primary |
Entity Name | Ochsner Mississippi, Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1538674239 PECOS PAC ID: 0143580993 Enrollment ID: O20180216000366 |
Mailing Address | Practice Location Address |
---|---|
Courtney A Clark, DO 1514 Jefferson Hwy, New Orleans, LA 70121-2429 Ph: (504) 842-4000 | Courtney A Clark, DO 2274 Highway 43 S, Picayune, MS 39466-8141 Ph: (601) 347-9024 |
Amy Duthu Eagan, Pediatrics Medicare: Medicare Enrolled Practice Location: 146 Highland Pkwy Ste A, Picayune, MS 39466 Phone: 601-358-9832 Fax: 601-358-9929 | |
Dr. Ashraf Tabatabaii, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 421 River Rd, Picayune, MS 39466 Phone: 601-798-0511 | |
Dr. April Michelle Ross, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2274 Highway 43 S, Picayune, MS 39466 Phone: 601-798-3989 Fax: 601-798-3964 |