Provider Demographics
NPI:1780460808
Name:CLARK, CAROLINE MCCALL (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:MCCALL
Last Name:CLARK
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Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:1100 JOHNSON FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:404-250-6691
Mailing Address - Fax:404-250-8847
Practice Address - Street 1:1100 JOHNSON FERRY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1709
Practice Address - Country:US
Practice Address - Phone:404-250-6691
Practice Address - Fax:404-250-8847
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2024-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA11815363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant