JERROLD A CLARK MD, NPI 1700866324
Pathology in MARIETTA, GA
Last Updated on : May 29,2015
About JERROLD A CLARK (NPI 1700866324)
JERROLD A CLARK is a Pathology provider in MARIETTA, United States. His medical specialization is Pathology with a focus in Anatomic Pathology & Clinical Pathology.
1700866324 is NPI number of JERROLD A CLARK.
JERROLD A CLARK's primary taxonomy code based on NPI Lookup is 207ZP0102X with license number 026841. This taxonomy code refers to Pathology.
JERROLD A CLARK has more than 16 years of experience.
JERROLD A CLARK current practice location address is 2275 NORTHWEST PARKWAY SE, MARIETTA, GA. JERROLD A CLARK can be reached out via phone at 770-951-1793 and via fax at 770-612-3380 .
You can also correspond with JERROLD A CLARK through mail at mailing address 14275 MIDWAY RD, ADDISON, TX, United States. Mailing address contact number is 770-951-1793.
The enumeration date of JERROLD A CLARK is 19-Jan-2006. The provider is registered as an Individual and the NPI record was last updated 8 years ago.1700866324 NPI Information
Basic NPI information of JERROLD A CLARK (NPI 1700866324) is provided below.
| Name | JERROLD A CLARK |
|---|---|
| National Provider Id (NPI) | 1700866324 |
| Entity Type | Individual |
| Gender | M |
| Credential | MD |
| Practice Address | 2275 NORTHWEST PARKWAY SE,
SUITE 140
MARIETTA, GA, United States |
| Practice Telephone | 770-951-1793 |
| Practice Fax Number | 770-612-3380 |
| Mailing Address | 14275 MIDWAY RD ,
SUITE 400
ADDISON, TX, United States |
| Mailing Telephone | 770-951-1793 |
| Mailing Fax Number | 610-271-4245 |
| Enumeration Date | 19-Jan-2006 |
| Last Updated Date | 29-May-2015 |
JERROLD A CLARK (NPI 1700866324) Primary Taxonomy Information
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs, the license data is associated to the taxonomy code.
| Primary | Taxonomy Code | Clasification | License Number | License State |
|---|---|---|---|---|
| Y | 207ZP0102X | Pathology, Anatomic Pathology & Clinical Pathology | 026841 | GA |
A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.
JERROLD A CLARK (NPI 1700866324) Secondary Taxonomy Information
The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs, the license data is associated to each taxonomy code.
| Primary | Taxonomy Code | Clasification | License Number | License State |
|---|---|---|---|---|
| N | 207ZB0001X | Pathology, Blood Banking & Transfusion Medicine | 026841 | GA |
Additional Identifiers
Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type/Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 000302112A | MEDICAID (05) | GA | |
| 202I220225 | MEDICAID (05) | GA | |
| 220014937 | MEDICARE PIN (08) | GA | |
| 22CDBFR | MEDICARE PIN (08) | ||
| 345972 | Other (non-Medicare) (01) | GA | WELLCARE |
| 52235375 005 | Other (non-Medicare) (01) | GA | BCBS COLISEUM |
| 52235375 006 | Other (non-Medicare) (01) | GA | BCBS MONROE |
| 52235375 007 | Other (non-Medicare) (01) | GA | BCBS MACON NORTHSIDE |
| 52235375 008 | Other (non-Medicare) (01) | GA | BCBS BLECKLEY |
| 52235375 009 | Other (non-Medicare) (01) | GA | BCBS MARIETTA |
| 581267100 | Other (non-Medicare) (01) | GA | TRICARE |
| D39603 | MEDICARE UPIN (02) | GA |
JERROLD A CLARK (NPI 1700866324) Office Location
Office location of JERROLD A CLARK is provided in the Google maps below.Providers in same location
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05-Jun-2020 |
| 1194291021 | 100YEARDOC, LLC | Chiropractor | 1135 S MARIETTA PKWY SE,
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18-Oct-2018 |
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11-Oct-2021 |
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| 1295473767 | 2DRS PLUS INVESTMENT GROUP, LLC | Physical Therapist, Neurology | 2745 SANDY PLAINS RD STE 154,
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24-May-2022 |
| 1467910828 | 2ME HEALTHCARE,LLC | Home Health | 2586 CLUB VALLEY DRIVE NE,
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| 1871112342 | 4 SEASONS HOME CARE, INC. | In Home Supportive Care | 78 COLE ST NE STE 100,
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| 1871923144 | 525 BRIDGEWATER LLC. | Technician, Personal Care Attendant | 3233 WARREN CREEK DRIVE,
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22-Nov-2013 |
| 1578733903 | A & J FAMILY CHIROPRACTIC INC. | Chiropractor | 1075 WHITLOCK AVE SW,
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29-Feb-2008 |
| 1356985303 | A BREATH OF FRESH AIR COUNSELING LLC | Counselor, Professional | 55 ATLANTA ST SE,
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02-Nov-2019 |
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16-Feb-2015 |
| 1194179861 | A HUMBLING SPIRIT FAMILY PRACTICE, INC. | Point of Service | PO BOX 2198,
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19-Apr-2016 |
| 1194903930 | A NEW DAWN THERAPY COMPANY | Physical Therapist | 1155 MALIBU DR,
MARIETTA, GA, United States |
04-Feb-2008 |
| 1972943066 | A NEW DAWN TURNING POINT, LLC | Psychologist, Addiction (Substance Use Disorder) | 2483 POWDER SPRINGS RD SW,
STE. B MARIETTA, GA, United States |
03-Jul-2013 |
| 1336893221 | A ONE HOME CARE SERVICES, INC | Home Health | 2255 SEWELL MILL RD,
MARIETTA, GA, United States |
09-Feb-2022 |
How to check whether NPI 1063496693 is valid?
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FAQs
Whose NPI Number is 1700866324?1700866324 is the NPI number of JERROLD A CLARK.
What is the specialty for JERROLD A CLARK?The Specialty of JERROLD A CLARK is Pathology.
NPI number meaning
| Field Name | Field Value |
|---|---|
| NPI | 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. |
| Entity Type | Code describing the type of health care provider that is being assigned an NPI.
Codes are:
|
| Provider Business Mailing Address | The mailing address of the provider being identified contains First line, Second Line, City name, State name, Postal code, and Country code. |
| Provider Business Mailing Address Telephone Number | The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number". |
| Provider Business Mailing Address Fax Number | The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''. |
| Provider Business Practice Location Address Telephone Number | The telephone number associated with the location address of the provider being identified. |
| Provider Business Practice Location Address Fax Number | The fax number associated with the location address of the provider being identified. |
| Provider Enumeration Date | The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date | The date that a record was last updated or changed. |
| Authorized Official Telephone Number | The 10-position telephone number of the authorized official. |
| Healthcare Provider Taxonomy Code | The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. |
| Healthcare Provider Taxonomy | Taxonomy Description of the Healthcare Provider. |
| Provider License Number | Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. |
| Provider License Number State Code | Provider License Number State Code #1 |
| Healthcare Provider Primary Taxonomy Switch | Primary Taxonomy:
|