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General NPI Number Information
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NPI Number | 1952574550
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Entity Type | Organization
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Legal Business Name | J MARK GRESHAM MD PC
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 301 JONES AVE
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City | WAYNESBORO
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State | GA
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Zip | 30830-1510
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Country | US
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Telephone | 706-437-0770
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Fax | 706-437-0540
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Provider Business Mailing Address
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Address Line | 301 JONES AVE P O BOX 328
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City | WAYNESBORO
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State | GA
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Zip | 30830-1510
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Country | US
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Telephone | 706-437-0770
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Fax | 706-437-0540
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONES MARK GRESHAM
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Credential | M.D.
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Telephone | 706-437-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 039358
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License Number State | GA
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