Healthcare Provider Details

I. General information

NPI: 1083009930
Provider Name (Legal Business Name): MARK OWUSU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 REYNOLDS ST STE 222
SAVANNAH GA
31405-6009
US

IV. Provider business mailing address

5354 REYNOLDS ST STE 222
SAVANNAH GA
31405-6009
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-5999
  • Fax: 912-819-5980
Mailing address:
  • Phone: 912-819-5999
  • Fax: 912-819-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTP789
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number111039
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4273
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: