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PRINCESS CLARK APRN
NPI 1679082549
Nurse Practitioner - Family in Alpharetta, GA

Active since September 23, 2017PECOS EnrolledAccepts Medicare Assignment
3905 BROOKSIDE PKWY STE 300, ALPHARETTA, GA 30022(770) 442-1911(770) 442-0306 Get Directions Write a Review

NPPES record last updated: May 10, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: May 10, 2024, Jun 27, 2018, Mar 17, 2018 and 1 more (4 updates tracked since 2017).

About Princess Clark Aprn NPPES

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

PRINCESS CLARK APRN (NPI 1679082549) is an individual family provider in Alpharetta, Georgia, licensed in Georgia (RN128145) and active in the NPI registry since September 2017. She is enrolled in Medicare PECOS, maintains 4 additional practice locations, and is a graduate of Other (2013).

NPPES Registry Identity

NPI1679082549
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NamePRINCESS CLARKCredential: APRN
Location Address3905 BROOKSIDE PKWY STE 300Alpharetta, GA 30022-4458
Mailing AddressPo Box 80883Athens, GA 30608-0883 · (706) 549-8114 · Fax (404) 384-6807
Phone(770) 442-1911
Fax(770) 442-0306
Sole ProprietorNo
Medical School CMSOtherGraduated 2013
Enumeration DateSeptember 23, 2017
Last NPPES UpdateMay 10, 20244 updates tracked since enumeration
NPPES CertifiedMay 10, 2024
✔ NPI 1679082549 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in GA · RN128145
3905 BROOKSIDE PKWY STE 300, Alpharetta, GA 30022
Open in Google Maps ↗

Secondary Practice Locations 4

Location 118 Riverbend Dr SW Ste 120Rome, GA 30161-6019 · Phone (706) 378-1202 · Fax (706) 378-1204
Location 276 Highland Pavilion Ct Ste 133Hiram, GA 30141-3170 · Phone (770) 439-1172 · Fax (706) 378-1204
Location 31503 Professional CtDalton, GA 30720 · Phone (706) 281-2121 · Fax (706) 378-1204
Location 41504 N Thornton Ave Ste 107Dalton, GA 30720-8394 · Phone (706) 278-0138

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc..Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Princess Clark Aprn is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID749547578
PECOS Enrollment IDI20171201002138
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Princess Clark reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Southeast Medical Group, P.C.
Same address
Family Medicine
3905 BROOKSIDE PKWY STE 300
Alpharetta, GA 30022
  • Reassigned Medicare billing, Georgia enrollment
  • 240 clinicians in this Medicare group
NPI 1235296054 (770) 442-1911
Utm Of Georgia Physicians LLC
84 mi
Family Medicine
400 BATTLEFIELD PKWY
Fort Oglethorpe, GA 30742
  • Reassigned Medicare billing, Georgia enrollment
  • 37 clinicians in this Medicare group
NPI 1255893038 (615) 988-2009

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30022 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$88.06 typical visit price
range $56.84 – $172.43
Typical copayment $22.01 (range $14.21 – $43.10)
Most-billed visit code 99203
Established Patient
$100.20 typical visit price
range $18.22 – $140.40
Typical copayment $25.05 (range $4.55 – $35.10)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. LUCE W. SOLARI-SUPRENA ARNP, FNP-BC
Nurse Practitioner (Primary Care)
3905 BROOKSIDE PKWY STE 300
ALPHARETTA, GA 30022
Fulton County (770) 442-1911
JENNIFER SADDANATHAN PHARMD
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)
3905 BROOKSIDE PKWY STE 300
ALPHARETTA, GA 30022
Fulton County (770) 442-1911
GINA LEEANN BAUKNECHT FNP-C
Nurse Practitioner (Family)
3905 BROOKSIDE PKWY STE 300
ALPHARETTA, GA 30022
Fulton County (770) 442-1911
DR. SATISHKUMAR MUDDURANGANATH GANJAM MD
Family Medicine
3905 BROOKSIDE PKWY STE 300
ALPHARETTA, GA 30022
Fulton County (770) 442-1911
YERIE YANG MD
Family Medicine
3905 BROOKSIDE PKWY STE 300
ALPHARETTA, GA 30022
Fulton County (770) 442-1911
SOUTHEAST MEDICAL GROUP, P.C.
Family Medicine
3905 BROOKSIDE PKWY STE 300
ALPHARETTA, GA 30022
Fulton County (770) 442-1911
CHUNG YOON M.D.
Internal Medicine (Cardiovascular Disease)
3905 BROOKSIDE PKWY STE 300
ALPHARETTA, GA 30022
Fulton County (770) 442-1911
DR. DANIELLE WILLIAMSON LIN MD
Family Medicine
3905 BROOKSIDE PKWY STE 300
ALPHARETTA, GA 30022
Fulton County (770) 442-1911

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 Princess Clark's NPI number?

The NPI number for Princess Clark is 1679082549. It was assigned to this individual provider in the NPPES registry on September 23, 2017.

Where is Princess Clark located?

Princess Clark practices at 3905 Brookside Pkwy Ste 300, Alpharetta, GA 30022. The listed phone number is (770) 442-1911.

What is Princess Clark's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Princess Clark enrolled in Medicare?

Yes. Princess Clark is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Princess Clark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Princess Clark reassigns Medicare benefits to 2 organizations: Southeast Medical Group, P.C. (Alpharetta, GA) and Utm Of Georgia Physicians LLC (Fort Oglethorpe, GA). Each 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 Princess Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Princess Clark accept?

Health plans from Alliant Health Plans, Inc. list Princess Clark 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 Princess Clark was last updated on May 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.