Healthcare Provider Details

I. General information

NPI: 1659323301
Provider Name (Legal Business Name): MARK A PLUNKETT M.D. OB/GYN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 VAN AALST BLVD
FORT BENNING GA
31905-2102
US

IV. Provider business mailing address

PO BOX 9186 WVU DEPT OF OBSTETRICS AND GYNECOLOGY
MORGANTOWN WV
26506-9186
US

V. Phone/Fax

Practice location:
  • Phone: 762-408-2605
  • Fax:
Mailing address:
  • Phone: 304-293-5631
  • Fax: 304-293-2131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number70932
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: