DR. JERROLD A CLARK


Address: 2275 Northwest Parkway Se, Suite 140, Marietta, GA 30067-9319
Phone: 7709511793

DR. JERROLD A CLARK (NPI# 1700866324) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1700866324
Entity Type Individual
Full Name DR. JERROLD A CLARK
Credential MD
Practice Address 2275 Northwest Parkway Se
Suite 140
Marietta
GA 30067-9319
Mailing Address 14275 Midway Rd
Suite 400
Addison
TX 75001-3614
Practice Telephone 7709511793
Practice Fax Number 7706123380
Mailing Telephone 7709511793
Mailing Fax Number 6102714245
Enumeration Date 2006-01-19
Last Update Date 2015-05-29
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 207ZB0001X Pathology
Specialization: Blood Banking & Transfusion Medicine
026841 GA Allopathic & Osteopathic Physicians
Y 207ZP0102X Pathology
Specialization: Anatomic Pathology & Clinical Pathology
026841 GA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
GA BCBS MONROE 52235375 006 01
GA BCBS COLISEUM 52235375 005 01
GA BCBS MARIETTA 52235375 009 01
GA 000302112A 05
GA 202I220225 05
GA BCBS BLECKLEY 52235375 008 01
GA WELLCARE 345972 01
GA TRICARE 581267100 01
GA BCBS MACON NORTHSIDE 52235375 007 01

Office Location

Street Address 2275 NORTHWEST PARKWAY SE
SUITE 140
City MARIETTA
State GA
Zip Code 30067-9319

Providers in the same location

NPI Name Taxonomy Address Enumeration
1366658437 Lynn D Cooper Pathology 2275 Northwest Parkway Se, Suite 140, Marietta, GA 30067-9319 2007-05-15
1164560876 Sara Elizabeth Nash Pathology 2275 Northwest Parkway Se, Suite 140, Marietta, GA 30067-9319 2007-02-02

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1689140022 Sherry Wilson King Marriage & Family Therapist 1640 Powers Ferry Rd Blg 7, Ste 300, Marietta, GA 30067 2018-10-23
1053886861 Precious Angel Home Care Services Inc Adult Companion 2470 Windy Hill Road, Marietta, Suite 253, Marietta, GA 30067 2018-10-08
1194206466 Joshua P Moree Chiropractor 860 Franklin Gtwy Se Apt 111, Marietta, GA 30067 2018-08-24
1841778081 Sun Pediatrics LLC Pediatrics 2520 Windy Hill Rd Se Ste 104, Marietta, GA 30067 2018-07-31
1508358714 Mbs Wellness Group, LLC Durable Medical Equipment & Medical Supplies 62 Shawnee Trail Se, Marietta, GA 30067 2018-06-04
1497254213 Allison M Jancik Chiropractor 1355 Terrell Mill Road Se, Bldg 1474, Ste 150, Marietta, GA 30067 2018-02-07
1801304969 Danielle Ann Dietrich Chiropractor 805 Winterset Pkwy Se, Marietta, GA 30067 2018-01-11
1740794866 Jessica Lofgren Chiropractor 1130 Northchase Pkwy Se Ste 125, Marietta, GA 30067 2017-11-28
1871026393 Rhonda Dawes Milner Counselor 1640 Powers Ferry Rd Bldg 16, Suite 100, Marietta, GA 30067 2017-04-11
1457894537 Carcelia Delk Counselor 1110 Augusta Dr Se, Marietta, GA 30067 2016-11-22
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Taxonomy Information

Taxonomy Code 207ZP0102X
Grouping Allopathic & Osteopathic Physicians
Classification Pathology
Specialization Anatomic Pathology & Clinical Pathology

Taxonomy Definition

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.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1487604849 Judy H. Sequeira Pathology 488 Kennesaw Ave Nw, Suite 200, Marietta, GA 30060-9409 2006-05-10
1760444186 Hany M Bishara Pathology 833 Campbell Hill St, Suite 111, Marietta, GA 30060 2006-04-03
1508090937 Sara Acree Pathology 677 Church St Ne, Department of Pathology, Marietta, GA 30060-1101 2009-05-13
1164669388 Tri County Pathology Associates Lab Pathology 833 Campbell Hill St Nw, Suite 111, Marietta, GA 30060-1134 2009-01-09
1356587109 Matthew J Macatol Md Pathology 401 Matthew St, Marietta, OH 45750-1635 2008-12-29
1245412402 Fortunato R Macatol Pathology 401 Matthew St, Marietta, OH 45750-1635 2007-11-29
1912199720 Matthew J Macatol Pathology 401 Matthew St, Marietta, OH 45750-1635 2007-08-15
1336270875 Aimee Popp Pathology 677 Church St Ne, Marietta, GA 30060-1101 2007-03-08
1073653655 Burton Kim Pathology 677 Church St Ne, Marietta, GA 30060-1101 2007-02-06
1164560876 Sara Elizabeth Nash Pathology 2275 Northwest Parkway Se, Suite 140, Marietta, GA 30067-9319 2007-02-02
Find all providers in MARIETTA

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City MARIETTA
Zip Code 30067

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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