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General NPI Number Information
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NPI Number | 1437158979
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Entity Type | Individual
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Provider Name | MARK HOFSTETTER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 1224 AUGUSTA WEST PKWY
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City | AUGUSTA
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State | GA
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Zip | 30909-6582
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Country | US
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Telephone | 706-922-0191
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Fax | 706-922-0192
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Provider Business Mailing Address
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Address Line | 1224 AUGUSTA WEST PKWY
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City | AUGUSTA
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State | GA
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Zip | 30909-6582
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Country | US
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Telephone | 706-922-0191
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Fax | 706-922-0192
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 067643
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License Number State | GA
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