MEDICARE: MR. MARK JAMES MAYSON 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	207RP1001X	Pulmonary Disease Physician	15931	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	F089605771	OTHER	SC	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1962480889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK JAMES MAYSON MD

Provider Business Mailing Address
First Line	:	PO BOX 743904
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3904
Country	:	US
Telephone Number	:	803-296-3273
Fax Number	:	803-296-7061

Provider Business Practice Location Address
First Line	:	1333 TAYLOR ST
Second Line	:	SUITE 4-G
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2923
Country	:	US
Telephone Number	:	803-296-3273
Fax Number	:	803-296-7061

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	02/19/2021

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Directions to “ MR. MARK JAMES MAYSON MD” Practice Location

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