Healthcare Provider Details

I. General information

NPI: 1164414769
Provider Name (Legal Business Name): MARK T MESSENGER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 WASHINGTON RD
THOMSON GA
30824-7318
US

IV. Provider business mailing address

1043 WASHINGTON RD
THOMSON GA
30824-7318
US

V. Phone/Fax

Practice location:
  • Phone: 706-597-0102
  • Fax: 706-597-1998
Mailing address:
  • Phone: 706-597-0102
  • Fax: 706-597-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD000713
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: