Basic Information
| Provider Information | |||||||||
| NPI: | 1497797633 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLARKE | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 73288 | ||||||||
| Address2: | |||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302713288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788579924 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1364 CLIFTON RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047785334 | ||||||||
| FaxNumber: | 4047784181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 09/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | K2667 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 060570 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 84556 | 01 | AR | BCBS-AR | OTHER | 8X9802 | 01 | TX | BCBS TEXAS | OTHER | 1395212-18 | 05 | TX | MEDICAID | 163717001 | 05 | AR | MEDICAID | P00466539 | 01 | TX | RR MEDICARE | OTHER |