| Clark Medical Group, Llc | |
|
117 Hill Pond Ln Statesboro GA 30458-0872 | |
| (912) 623-2155 | |
| (912) 623-2156 |
| Full Name | Clark Medical Group, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 117 Hill Pond Ln, Statesboro, Georgia |
| Authorized Official Name and Position | Aaron Clark (OWNER) |
| Authorized Official Contact | 9126232155 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clark Medical Group, Llc 117 Hill Pond Ln Statesboro GA 30458-0872 Ph: (912) 623-2155 | Clark Medical Group, Llc 117 Hill Pond Ln Statesboro GA 30458-0872 Ph: (912) 623-2155 |
| NPI Number | 1477927192 |
|---|---|
| Provider Enumeration Date | 11/18/2015 |
| Last Update Date | 07/20/2020 |
| Medicare PECOS PAC ID | 8820390347 |
|---|---|
| Medicare Enrollment ID | O20151230000533 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477927192 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 66012 (Georgia) | Primary |
| Provider Name | Aaron Taylor Clark |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134439581 PECOS PAC ID: 8325226772 Enrollment ID: I20110707000215 |
| Provider Name | Iris Clark |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174887004 PECOS PAC ID: 6305085259 Enrollment ID: I20151103003225 |
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