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Contact Information

JERROLD A CLARK, MD
2275 NORTHWEST PARKWAY SE
SUITE 140
MARIETTA, GA30067-9319
 Phone: 770-951-1793
 Fax: 770-612-3380
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anatomic Pathology & Clinical Pathology

207ZP0102X 22 Physician/Pathology
 

Blood Banking & Transfusion Medicine

207ZB0001X 22 Physician/Pathology
Indicates primary specialty

NPI Profile & details for JERROLD A CLARK · (Male)

NPI # 1700866324
Status Active
Credentials MD
Entity Individual
Enumeration date 01/19/2006
Last updated 05/29/2015 - About 11 years ago
Sole proprietor 1 No
Identifiers
  • GA License # 026841
  • GA Medicaid 000302112A
  • GA Medicaid 202I220225
  • GA Other 52235375 008 BCBS BLECKLEY
  • GA Other 52235375 005 BCBS COLISEUM
  • GA Other 52235375 007 BCBS MACON NORTHSIDE
  • GA Other 52235375 009 BCBS MARIETTA
  • GA Other 52235375 006 BCBS MONROE
  • GA Other 581267100 TRICARE
  • GA Other 345972 WELLCARE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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