ADELE CLARK


Address: 4618 Country Club Rd, Winston Salem, NC 27104-3520
Phone: 3367162255

ADELE CLARK (NPI# 1841228335) 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) 1841228335
Entity Type Individual
Full Name ADELE CLARK
Credential PA
Practice Address 4618 Country Club Rd
Winston Salem
NC 27104-3520
Mailing Address Po Box 344
Winston-salem
NC 27102-0344
Practice Telephone 3367162255
Practice Fax Number 3367169258
Mailing Telephone 3367162255
Mailing Fax Number 3367169258
Enumeration Date 2006-06-30
Last Update Date 2010-10-21
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AM0700X Physician Assistant
Specialization: Medical
100690 NC Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
NC MEDCOST 189348 01
NC AETNA 7825786 01

Other Providers ADELE CLARK

NPI Name Taxonomy Address Enumeration
1962863753 Adele Jane Clark Chiropractor 23100 Pacific Hwy S Ste 201, Des Moines, WA 98198-7281 2016-03-08

Office Location

Street Address 4618 COUNTRY CLUB RD
City WINSTON SALEM
State NC
Zip Code 27104-3520

Providers in the same location

NPI Name Taxonomy Address Enumeration
1720063175 Steven Richard Feldman Dermatology 4618 Country Club Rd, Winston Salem, NC 27104-3520 2005-12-08
1487213047 Diana Isabel Munoz Ali Nurse Practitioner 4618 Country Club Rd, Winston Salem, NC 27104-3520 2019-06-07
1629544689 Kimberly Kincaid Mcpeeks Dermatology 4618 Country Club Rd, Winston Salem, NC 27104-3520 2018-10-17
1861842031 Leonora Culp Bomar Dermatology 4618 Country Club Rd, Winston Salem, NC 27104-3520 2016-06-17
1912392903 Melissa Brooke Hoffman Student in an Organized Health Care Education/Training Program 4618 Country Club Rd, Winston Salem, NC 27104-3520 2015-04-06
1083031090 Jessica Alexis Savas Dermatology 4618 Country Club Rd, Winston Salem, NC 27104-3520 2014-03-27
1164779997 Amber Brewer Keller Physician Assistant 4618 Country Club Rd, Winston Salem, NC 27104-3520 2012-08-10
1629272455 William Wei-ting Huang Dermatology 4618 Country Club Rd, Winston Salem, NC 27104-3520 2007-06-14
1316923360 Joseph Lucius Jorizzo Dermatology 4618 Country Club Rd, Winston Salem, NC 27104-3520 2005-12-21
1518943943 Phillip Mabon Williford Dermatology 4618 Country Club Rd, Winston Salem, NC 27104-3520 2005-12-19
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1447807664 Cameron Grant Ford Psychologist 614 Country Club Road, Winston-salem, NC 27104 2019-08-22
1104310374 Novant Medical Group, Inc. Internal Medicine 4937 Old Country Club Rd, Winston Salem, NC 27104 2018-06-20
1982100509 Dillon James Magalski Student in an Organized Health Care Education/Training Program Piedmont Plaza 1, 1920 West First Street, Wake Forest Baptist Medical Center, Winston-salem, NC 27104 2018-04-03
1891290144 Breann M Poling Student in an Organized Health Care Education/Training Program Wake Forest Baptist Medical Center, Department Of, Family Medicine Piedmont Plaza I 1920 West First Street, Winston Salem, NC 27104 2018-03-28
1689178600 Christopher Vasil Student in an Organized Health Care Education/Training Program Piedmont Plaza I, 1920 West First Street, Department of Family Medicine, Winston Salem, NC 27104 2018-03-23
1407379126 April Lynn Lowe Registered Nurse 940 N Peace Haven Rd, Winstonsalem, NC 27104 2017-07-25
1164950804 Donald Joyce Student in an Organized Health Care Education/Training Program 1920 West First St, Piedmont Plaza I Building, 3rd Floor, Winston-salem, NC 27104 2017-05-25
1255867289 Benjamin Hansen Pharmacist 2150 Country Club Rd Ste 300, Winston Salem, NC 27104 2017-05-11
1770020976 Jane Reed Physical Medicine & Rehabilitation 2627 E Greenbrier Road, Winston Salem, NC 27104 2017-01-25
1053728261 Ashraf Alsaedi Pharmacist 1659 Stratford Rd Nw, Winston Salem, NC 27104 2014-07-20
Find all providers in zip 27104

Taxonomy Information

Taxonomy Code 363AM0700X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Medical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1629692439 Julie Anne Augustine Physician Assistant 718 S Green St, Winston Salem, NC 27101-5112 2020-06-08
1932674090 Erin Baxter Caldwell Physician Assistant 2953 Buena Vista Rd, Winston Salem, NC 27106-5724 2018-10-04
1376054106 Tara Mckenzie Physician Assistant 1 Medical Center Blvd Hosptial Medicine, Winston Salem, NC 27157-0001 2017-10-19
1154866382 Camilla Potts Leonard Physician Assistant 503 Thurston St, Winston Salem, NC 27103-1609 2016-12-26
1427591379 Darrell Justin Ratcliffe Physician Assistant 1500 W Academy St, Winston Salem, NC 27103-3849 2016-11-27
1881825917 Mark Elno Archambault Physician Assistant Department of Physician Assistant Studies, Medical Center Blvd, Winston Salem, NC 27157-1006 2009-08-06
1659519551 John Clifton Harper Jr. Physician Assistant 206 W Clemmonsville Rd, Winston Salem, NC 27127-5124 2009-01-30
1710070602 John Joseph Dewar Sr. Physician Assistant 1399 Ashleybrook Ln Ste 100, Winston Salem, NC 27103-2961 2006-10-02
1871515866 Beth Gurley Physician Assistant 765 Highland Oaks Dr, Suite 100, Winston Salem, NC 27103-7101 2006-07-25
1801845722 Mark A Pane Physician Assistant 3333 Brookview Hills Blvd Ste 104, Winston Salem, NC 27103-5661 2006-05-08
Find all providers in WINSTON SALEM

Competitor

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City WINSTON SALEM
Zip Code 27104

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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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