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NPI Code Detail

MEDICARE: MRS. ASHLEIGH MEGAN CLARK CNP

MEDICARE: MRS. ASHLEIGH MEGAN CLARK CNP
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
1363LF0000XFamily Nurse PractitionerAPRN-NP216838GA

General Provider Information

NPI Number : 1457749947
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ASHLEIGH MEGAN CLARK CNP
Provider Business Mailing Address
First Line : 4557 SAVAGE DR NE
Second Line :
City : MARIETTA
State : GA
Zip : 30066-6913
Country : US
Telephone Number : 404-933-6333
Fax Number :
Provider Business Practice Location Address
First Line : 100 PIEDMONT RD
Second Line :
City : MARIETTA
State : GA
Zip : 30066-3636
Country : US
Telephone Number : 770-795-7085
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2015
Last Update Date : 01/19/2026

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