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General NPI Number Information
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NPI Number | 1538398375
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Entity Type | Individual
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Provider Name | AARON CORNELIUS CLARK MD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 06/15/2018
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Provider Practice Location Address
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Address Line | 3073 PANTHERSVILLE RD
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City | DECATUR
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State | GA
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Zip | 30034
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Country | US
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Telephone | 404-243-2100
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Fax | 423-439-6259
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Provider Business Mailing Address
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Address Line | 3706 MEADOW VISTA TRL
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City | LITHONIA
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State | GA
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Zip | 30038-7736
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Country | US
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Telephone | 404-316-7159
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 073439
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License Number State | GA
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