Healthcare Provider Details

I. General information

NPI: 1689590143
Provider Name (Legal Business Name): SAVANNA CLARK BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1274 JOE FRANK HARRIS PKWY SE
CARTERSVILLE GA
30120-4211
US

IV. Provider business mailing address

345 PARKWAY 575
WOODSTOCK GA
30188-3897
US

V. Phone/Fax

Practice location:
  • Phone: 470-473-5920
  • Fax: 888-979-8504
Mailing address:
  • Phone: 470-473-5920
  • Fax: 888-979-8504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-91010
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: