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CLARK FAMILY CARE
NPI 1114594389
Clinic/Center - Primary Care in Sylvania, GA

Active since June 07, 2021CLIA 11D2246866 · Waiver
715 W OGEECHEE ST, SYLVANIA, GA 30467(912) 451-4100(912) 451-4105 Get Directions Write a Review

NPPES record last updated: March 1, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 1, 2023, Jan 18, 2022, Jun 7, 2021 (3 updates tracked since 2021).

About Clark Family Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLARK FAMILY CARE (NPI 1114594389) is a healthcare organization registered as a primary care in Sylvania, Georgia and active in the NPI registry since June 2021. The organization holds a CLIA Waiver certificate valid through December 29, 2027 and lists Kendall Clark, Fnp-c, as its authorized official.

NPPES Registry Identity

NPI1114594389
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameCLARK FAMILY CARE LLC
Location Address715 W OGEECHEE STSylvania, GA 30467-8693
Mailing AddressPo Box 194Sylvania, GA 30467-0194 · (912) 451-4100
Phone(912) 451-4100
Fax(912) 451-4105
Organization SubpartNo
Authorized OfficialKendall ClarkFnp-c · (912) 451-4100
Enumeration DateJune 7, 2021
Last NPPES UpdateMarch 1, 20233 updates tracked since enumeration
NPPES CertifiedMarch 1, 2023
✔ NPI 1114594389 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
715 W OGEECHEE ST, Sylvania, GA 30467
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Other Names 1

Doing Business AsClark Family Care

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Clark Family Care is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Clark Family Care, which bills Medicare for the services this clinician delivers.

Clinician (1)

Kendall Clark, FNP-C
Nurse Practitioner
NPI 1821489337
715 W OGEECHEE ST
Sylvania, GA 30467
(912) 451-4100
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2246866

Clark Family Care · Sylvania, GA
Active · expires Dec 29, 2027
CLIA Number11D2246866
Laboratory TypePractitioner Other
Certificate Effective DateDecember 30, 2025
Certificate Expiration DateDecember 29, 2027
Laboratory DirectorKendall Clark
Laboratory Phone(912) 451-4100
Laboratory LocationClark Family Care715 W Ogeechee Street, Sylvania, GA 30467
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Clark Family Care LLC's NPI number?

The NPI number for Clark Family Care LLC is 1114594389. It was assigned to this organization in the NPPES registry on June 7, 2021. The provider is doing business as Clark Family Care.

Where is Clark Family Care LLC located?

Clark Family Care LLC is located at 715 W Ogeechee St, Sylvania, GA 30467. The listed phone number is (912) 451-4100.

What is Clark Family Care LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Is Clark Family Care LLC enrolled in Medicare?

Yes. Clark Family Care LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Clark Family Care LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Clark Family Care LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Clark Family Care LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2246866) is associated with this NPI, valid through December 29, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Clark Family Care LLC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Clark Family Care LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Clark Family Care LLC was last updated on March 1, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.