NPI age
19 years
Enumerated 2006-07-05
● Active Type 2 · Organization
Robert B Clark JR MD Llc
Robert B Clark JR MD Llc is 1 of 1881 specialist organizations in Georgia.
Primary specialty
Specialist
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Edge
Credentialing
Last NPPES update
2013-03-27
Source: monthly bulk 2026-05
How this organization compares
Across 1881 active specialist providers in Georgia.
NPI age
19 years
≈ at median (19 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2006 → 2026
2006-07Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
1811 Manning Drive
Vidalia, GA 30474
Mailing address
1811 Manning Drive
Vidalia, GA 30474
Authorized official
Priscilla E Edge
Credentialing
📞 9125378691
Specialties
-
Specialist PrimaryAn individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 449866340 | MEDICAID REFERRAL |
| 05 (GA) | 000177713D | |
| 01 (GU) | 1144289349 | PERSONAL NPI NUMBER 1144289349 |
| 01 (GA) | GRP7739 | MEDICARE GROUP NUMBER |
Practice context
Single-site organization. Only one practice location on file.
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