MEDICARE: SABRINA CLARK

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	171W00000X	Contractor		GA

General Provider Information

NPI Number	:	1669316063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABRINA CLARK

Provider Business Mailing Address
First Line	:	2801 CRESCENDO DR NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-6045
Country	:	US
Telephone Number	:	404-217-2449
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 CRESCENDO DR NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-6045
Country	:	US
Telephone Number	:	404-217-2449
Fax Number	:

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

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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Directions to “ SABRINA CLARK ” Practice Location

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