Provider Demographics
NPI:1659412898
Name:TERESA E CLARK MD PC
Entity Type:Organization
Organization Name:TERESA E CLARK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-444-4886
Mailing Address - Street 1:1003 CORONADO DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3716
Mailing Address - Country:US
Mailing Address - Phone:404-444-4886
Mailing Address - Fax:404-581-5440
Practice Address - Street 1:1003 CORONADO DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-3716
Practice Address - Country:US
Practice Address - Phone:404-444-4886
Practice Address - Fax:404-581-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty