MEDICARE: DR. STUART D. MARKS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	GA30348	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306849658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART D. MARKS M.D.

Provider Business Mailing Address
First Line	:	905 STEVENS CREEK RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30907-3201
Country	:	US
Telephone Number	:	706-922-6000
Fax Number	:	706-722-7994

Provider Business Practice Location Address
First Line	:	905 STEVENS CREEK RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30907-3201
Country	:	US
Telephone Number	:	706-922-6000
Fax Number	:	706-722-7994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	12/07/2007

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