Provider Demographics
NPI:1508881368
Name:CLARK, JELUNDER A WOODARD (MD)
Entity Type:Individual
Prefix:MRS
First Name:JELUNDER
Middle Name:A WOODARD
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JELUNDER
Other - Middle Name:W
Other - Last Name:WOODARD CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1331 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2357
Mailing Address - Country:US
Mailing Address - Phone:770-629-3217
Mailing Address - Fax:404-666-0085
Practice Address - Street 1:1331 MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2357
Practice Address - Country:US
Practice Address - Phone:770-629-3217
Practice Address - Fax:404-666-0085
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000949627AMedicaid
F85753Medicare UPIN
GA08BBQJPMedicare ID - Type Unspecified