MEDICARE: MARK J WARD MD

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	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	045360	GA

General Provider Information

NPI Number	:	1346427424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK J WARD MD

Provider Business Mailing Address
First Line	:	1680 TULLIE CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1680 TULLIE CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2321
Country	:	US
Telephone Number	:	404-785-7141
Fax Number	:

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

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	07/11/2008

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