Princess Clark, APRN - Medicare Nurse Practitioner in Alpharetta, GA

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Princess Clark, APRN is a medicare enrolled "Nurse Practitioner - Family" in Alpharetta, Georgia. Her current practice location is 3905 Brookside Pkwy Ste 300, Alpharetta, Georgia. You can reach out to her office (for appointments etc.) via phone at (770) 442-1911.

Princess Clark is licensed to practice in Georgia (license number RN128145) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1679082549.

Contact Information

Princess Clark, APRN
3905 Brookside Pkwy Ste 300,
Alpharetta, GA 30022-4458
(770) 442-1911
(770) 442-0306

Map and Direction




Provider's Profile

Full NamePrincess Clark
GenderFemale
SpecialityNurse Practitioner - Family
Location3905 Brookside Pkwy Ste 300, Alpharetta, Georgia
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1679082549
  • Provider Enumeration Date: 09/23/2017
  • Last Update Date: 05/10/2024
  Medicare PECOS Information:
  • PECOS PAC ID: 0749547578
  • Enrollment ID: I20171201002138

Medical Identifiers

Medical identifiers for Princess Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1679082549NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LF0000XNurse Practitioner - Family RN128145 (Georgia)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Princess Clark allows following entities to bill medicare on her behalf.
Entity NameSoutheast Medical Group, P.c.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1235296054
PECOS PAC ID: 3577559673
Enrollment ID: O20040423000347
Entity NameUtm Of Georgia Physicians Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1255893038
PECOS PAC ID: 5991138307
Enrollment ID: O20191125002037

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Princess Clark is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Princess Clark, APRN
Po Box 80883,
Athens, GA 30608-0883

Ph: (706) 549-8114		Princess Clark, APRN
3905 Brookside Pkwy Ste 300,
Alpharetta, GA 30022-4458

Ph: (770) 442-1911

Reviews and Comments


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Kathleen Marie Sklivagkos,
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Regan J Kudlata, RN FNP
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Joanna M Huff, APRN
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Practice Location: 44 Milton Ave, Alpharetta, GA 30009
Phone: 425-449-1571    
Gina Leeann Bauknecht, FNP-C
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Medicare: Medicare Enrolled
Practice Location: 3905 Brookside Pkwy Ste 300, Alpharetta, GA 30022
Phone: 770-442-1911    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.