MEDICARE: DR. MARK H. IVEY 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	2085R0202X	Diagnostic Radiology Physician	050106	GA

General Provider Information

NPI Number	:	1801878210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK H. IVEY M.D.

Provider Business Mailing Address
First Line	:	308 STATHAMS WAY
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-7521
Country	:	US
Telephone Number	:	478-929-4839
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 MARGIE DRIVE
Second Line	:	HEART OF GEORGIA MEDICAL ASSOCIATES
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-7817
Country	:	US
Telephone Number	:	478-953-0911
Fax Number	:

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

Provider Enumeration Date	:	11/19/2005
Last Update Date	:	04/20/2016

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