MEDICARE: MR. JOHN MARK SOLOMON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	27565	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548353360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MARK SOLOMON LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1012
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-1012
Country	:	US
Telephone Number	:	903-670-1420
Fax Number	:	903-670-2599

Provider Business Practice Location Address
First Line	:	506 RICHARDSON ST
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-3430
Country	:	US
Telephone Number	:	903-677-4800
Fax Number	:	903-677-4803

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/26/2009

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