MEDICARE: JABARI CLARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	052426494	GA

General Provider Information

NPI Number	:	1609578905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JABARI CLARK

Provider Business Mailing Address
First Line	:	9306 PERIMETER LOFTS CIR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30346-1753
Country	:	US
Telephone Number	:	404-210-2736
Fax Number	:

Provider Business Practice Location Address
First Line	:	9306 PERIMETER LOFTS CIR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30346-1753
Country	:	US
Telephone Number	:	404-210-2736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	04/26/2023

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Directions to “ JABARI CLARK ” Practice Location

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