Provider Demographics
NPI:1053421172
Name:HARVEY, MARK R (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:HARVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:203 MEDICAL ARTS PLACE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082
Mailing Address - Country:US
Mailing Address - Phone:478-552-0967
Mailing Address - Fax:478-552-8541
Practice Address - Street 1:203 MEDICAL ARTS PLACE
Practice Address - Street 2:SUITE 3
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082
Practice Address - Country:US
Practice Address - Phone:478-552-0967
Practice Address - Fax:478-552-8541
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-03-08
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Provider Licenses
StateLicense IDTaxonomies
GA033984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00456079AMedicaid
E78992Medicare UPIN
GA11BDDDCMedicare ID - Type Unspecified