MEDICARE: JUSTIN PATRICK CLARK M.D.

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	207Q00000X	Family Medicine Physician	2015027593	MO
2	207Q00000X	Family Medicine Physician	ME155207	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609135011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN PATRICK CLARK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 746638
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6638
Country	:	US
Telephone Number	:	904-202-1032
Fax Number	:	904-376-4107

Provider Business Practice Location Address
First Line	:	532 RIVERSIDE AVE STE 103
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-4914
Country	:	US
Telephone Number	:	904-353-5696
Fax Number	:	904-390-7483

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

Provider Enumeration Date	:	05/07/2012
Last Update Date	:	10/19/2022

Similar Medicare Providers

1548112014 — SAMANTHA LAINE SIMON
Practice Location Address:

532 RIVERSIDE AVE STE 103
JACKSONVILLE, FL
32202-4914

Practice Phone: 904-353-5696
Practice Fax:

1477572204 — DR. ALICIA CAMPBELL MD
Practice Location Address:

532 RIVERSIDE AVE
JACKSONVILLE, FL
32202-4914

Practice Phone: 904-791-0182
Practice Fax:

1316038847 — SANDRA B LAURENCIN M.D.
Practice Location Address:

532 RIVERSIDE AVE STE 103
JACKSONVILLE, FL
32202-4914

Practice Phone: 904-353-5696
Practice Fax: 904-353-2844

1013160704 — BAPTIST PRIMARY CARE INC
Practice Location Address:

532 RIVERSIDE AVE STE 103
JACKSONVILLE, FL
32202-4914

Practice Phone: 904-353-5696
Practice Fax: 904-390-7483

1295125615 — DR. JAMES CORCORAN JR. MD, MPH
Practice Location Address:

532 RIVERSIDE AVE , 20T
JACKSONVILLE, FL
32202-4914

Practice Phone: 904-791-8211
Practice Fax:

1265953954 — DR. ISAAC M KINMAN D.O.
Practice Location Address:

532 RIVERSIDE AVE STE 103
JACKSONVILLE, FL
32202-4914

Practice Phone: 904-353-5696
Practice Fax: 904-390-7483

Directions to “ JUSTIN PATRICK CLARK M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.