MEDICARE: MS. GEORGIANNA K. MARKS PHD, APRN, PC

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	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	124796	MA

General Provider Information

NPI Number	:	1396854394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GEORGIANNA K. MARKS PHD, APRN, PC

Provider Business Mailing Address
First Line	:	14 CUSHING AVE
Second Line	:	ST MARY'S CENTER
City	:	BOSTON
State	:	MA
Zip	:	02125
Country	:	US
Telephone Number	:	857-230-0983
Fax Number	:	866-610-6501

Provider Business Practice Location Address
First Line	:	14 CUSHING AVE
Second Line	:	ST MARY'S CHURCH
City	:	BOSTON
State	:	MA
Zip	:	02125
Country	:	US
Telephone Number	:	857-230-0983
Fax Number	:	866-610-6501

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	06/13/2016

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