Provider Demographics
NPI:1235932039
Name:CLARK, INASHJA
Entity type:Individual
Prefix:
First Name:INASHJA
Middle Name:
Last Name:CLARK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 WILLIAM TURNER PKWY APT 2419
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5184
Mailing Address - Country:US
Mailing Address - Phone:470-834-4917
Mailing Address - Fax:
Practice Address - Street 1:4100 WILLIAM TURNER PKWY APT 2419
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-5184
Practice Address - Country:US
Practice Address - Phone:470-834-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide