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General NPI Number Information
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NPI Number | 1063607828
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Entity Type | Organization
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Legal Business Name | MARK BYRON MD PC
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 162 MEMORIAL DR
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City | JESUP
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State | GA
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Zip | 31545-0101
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Country | US
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Telephone | 912-427-8033
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Fax |
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Provider Business Mailing Address
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Address Line | 162 MEMORIAL DR
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City | JESUP
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State | GA
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Zip | 31545-0101
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Country | US
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Telephone | 912-427-8033
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Fax | 912-427-7565
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Authorized Official
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Title or Position | MD OWNER
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Name | MARK DANIEL BYRON
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Credential | M.D.
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Telephone | 912-427-8033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 047579
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License Number State | GA
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