Provider Demographics
NPI:1053328294
Name:SALSBERRY, MARK D (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:SALSBERRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2487 CEDARCREST RD
Mailing Address - Street 2:SUITE 714
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-2728
Mailing Address - Country:US
Mailing Address - Phone:678-224-5730
Mailing Address - Fax:770-693-7186
Practice Address - Street 1:2487 CEDARCREST RD
Practice Address - Street 2:SUITE 714
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-2728
Practice Address - Country:US
Practice Address - Phone:678-224-5730
Practice Address - Fax:770-693-7186
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA039459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
08BBTVQMedicare ID - Type Unspecified
B34383Medicare UPIN