Healthcare Provider Details

I. General information

NPI: 1932223740
Provider Name (Legal Business Name): GREGORY PAUL MARKS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PHARR RD NE SUITE 325
ATLANTA GA
30305-3428
US

IV. Provider business mailing address

550 PHARR RD NE SUITE 325
ATLANTA GA
30305-3428
US

V. Phone/Fax

Practice location:
  • Phone: 404-233-8221
  • Fax: 404-233-5783
Mailing address:
  • Phone: 404-233-8221
  • Fax: 404-233-5783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10603
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: