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NPI Code Detail

MEDICARE: MARK THOMAS BATES M.D.

MEDICARE: MARK THOMAS BATES M.D.
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
1207R00000XInternal Medicine Physician047191GA

General Provider Information

NPI Number : 1639211378
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK THOMAS BATES M.D.
Provider Business Mailing Address
First Line : 2124 CANDLER RD
Second Line :
City : DECATUR
State : GA
Zip : 30032-5572
Country : US
Telephone Number : 404-836-0272
Fax Number : 404-666-0038
Provider Business Practice Location Address
First Line : 2124 CANDLER RD
Second Line :
City : DECATUR
State : GA
Zip : 30032-5572
Country : US
Telephone Number : 404-836-0272
Fax Number : 404-666-0038
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 11/28/2023

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