# DR. JANICE PATRECE CLARK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1811168339
- **Gender:** F
- **Credential:** DPM

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | POD001114 | GA | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 0689 | AZ | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | CL011 | NM | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | POD001114 | GA | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | R57676 | NY | — |

## Other

- **Enumeration date:** 03/13/2008
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1289105 | AMERIGROUP | GA |
| 01 | — | 2009-07-20 | CIGNA | GA |
| 01 | — | 2009-08-01 | UNITED HEALTHCARE | GA |
| 01 | — | 2009-10-01 | PSHP | GA |
| 01 | — | 20091544 | SELECT HEALTH | GA |
| 05 | — | 294861171A | — | GA |
| 01 | — | 519981 | WELLCARE | GA |
| 01 | — | 52246038-001 | BCBSGA | GA |
| 05 | — | GPD114 | — | SC |
| 01 | — | PAR | AETNA | GA |
| 01 | — | PAR-2009-07-20 | GREAT WEST | GA |
| 01 | — | PAR-2009-08-28 | TRICARE | GA |