MEDICARE: DR. MARY M ASPIN M.D. MSPH

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	208000000X	Pediatrics Physician	A45716	CA
2	2080P0208X	Pediatric Infectious Diseases Physician	A45716	CA
3	208000000X	Pediatrics Physician	87484	GA

General Provider Information

NPI Number	:	1639184328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY M ASPIN M.D. MSPH

Provider Business Mailing Address
First Line	:	1485 JESSE JEWELL PKWY NE STE 200
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3802
Country	:	US
Telephone Number	:	770-534-5255
Fax Number	:	770-287-3871

Provider Business Practice Location Address
First Line	:	1485 JESSE JEWELL PKWY NE STE 200
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3802
Country	:	US
Telephone Number	:	770-534-5255
Fax Number	:	770-287-3871

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	01/06/2022

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