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General NPI Number Information
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NPI Number | 1386527240
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Entity Type | Individual
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Provider Name | HENRY CLAYTON LARK IV CRNP
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Gender | Male
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 1670 CLAIRMONT RD
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City | DECATUR
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State | GA
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Zip | 30033-4004
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Country | US
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Telephone | 404-321-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 225 BEECH TREE HOLW
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City | SUGAR HILL
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State | GA
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Zip | 30518-8005
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Country | US
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Telephone | 570-269-5138
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN337850
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License Number State | GA
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