Provider Demographics
NPI:1679565444
Name:TURNER, JOHN-MARK (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN-MARK
Middle Name:
Last Name:TURNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 HIGHWAY 515 E
Mailing Address - Street 2:BLDG C
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3697
Mailing Address - Country:US
Mailing Address - Phone:706-745-3900
Mailing Address - Fax:706-745-2705
Practice Address - Street 1:253 HIGHWAY 515 E
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3697
Practice Address - Country:US
Practice Address - Phone:706-745-3900
Practice Address - Fax:706-745-2705
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001355152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4015462OtherBCBS TN
GA000515138AMedicaid
GA582200377OtherTIN
41ZCCBXMedicare PIN
0528750001Medicare NSC
GA000515138AMedicaid
GA0528750001Medicare ID - Type UnspecifiedPALMETTO GOVT BENEFITS