Healthcare Provider Details

I. General information

NPI: 1851373351
Provider Name (Legal Business Name): MARK M SUZUKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 MERCY BLVD BLDG 1
SAVANNAH GA
31419-1753
US

IV. Provider business mailing address

836 E 65TH ST STE 22
SAVANNAH GA
31405-4493
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-0500
  • Fax: 912-819-0501
Mailing address:
  • Phone: 912-819-2622
  • Fax: 912-691-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD064264L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number082117
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: