MEDICARE: MARK E BLANKENSHIP 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	208C00000X	Colon & Rectal Surgery Physician	043557	GA
2	208600000X	Surgery Physician	043557	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CN8505	OTHER	GA	RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1861492191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK E BLANKENSHIP MD

Provider Business Mailing Address
First Line	:	PO BOX 919
Second Line	:
City	:	RINCON
State	:	GA
Zip	:	31326-0919
Country	:	US
Telephone Number	:	912-826-4057
Fax Number	:	912-826-2853

Provider Business Practice Location Address
First Line	:	594 S COLUMBIA AVE
Second Line	:	STE 100
City	:	RINCON
State	:	GA
Zip	:	31326-0919
Country	:	US
Telephone Number	:	912-826-4057
Fax Number	:	912-826-2853

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	11/15/2007

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Directions to “ MARK E BLANKENSHIP MD” Practice Location

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