Healthcare Provider Details

I. General information

NPI: 1306849658
Provider Name (Legal Business Name): STUART D. MARKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 STEVENS CREEK RD
AUGUSTA GA
30907-3201
US

IV. Provider business mailing address

905 STEVENS CREEK RD
AUGUSTA GA
30907-3201
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-6000
  • Fax: 706-722-7994
Mailing address:
  • Phone: 706-922-6000
  • Fax: 706-722-7994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberGA30348
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: