Provider Demographics
NPI:1497797633
Name:CLARKE, KAREN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73288
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30271-3288
Mailing Address - Country:US
Mailing Address - Phone:678-857-9924
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1059
Practice Address - Country:US
Practice Address - Phone:404-778-5334
Practice Address - Fax:404-778-4181
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2667207R00000X
GA060570208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR84556OtherBCBS-AR
TX8X9802OtherBCBS TEXAS
TX1395212-18Medicaid
AR163717001Medicaid
TXP00466539OtherRR MEDICARE
TX8J0943Medicare PIN
AR84556OtherBCBS-AR