Provider Demographics
NPI:1538398375
Name:CLARK, AARON CORNELIUS (MD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:CORNELIUS
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3706 MEADOW VISTA TRL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-7736
Mailing Address - Country:US
Mailing Address - Phone:404-316-7159
Mailing Address - Fax:
Practice Address - Street 1:3073 PANTHERSVILLE RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034
Practice Address - Country:US
Practice Address - Phone:404-243-2100
Practice Address - Fax:423-439-6259
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0734392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry