Provider Demographics
NPI:1801814033
Name:CLARKE, NATALIE LAURA (MD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:LAURA
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 1:3827 HONORS WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9147
Mailing Address - Country:US
Mailing Address - Phone:706-339-1437
Mailing Address - Fax:706-863-6231
Practice Address - Street 1:393 N BELAIR RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3096
Practice Address - Country:US
Practice Address - Phone:706-339-1437
Practice Address - Fax:706-863-6231
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29100207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00365804OtherMEDICARE RR
SC291008Medicaid
SC291008Medicaid
SCAA14621729Medicare PIN
SCP00365804Medicare PIN