MEDICARE: MARK H EBELL 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	207Q00000X	Family Medicine Physician	032724	GA

General Provider Information

NPI Number	:	1982602520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK H EBELL M.D.

Provider Business Mailing Address
First Line	:	150 YONAH AVE
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30601-1740
Country	:	US
Telephone Number	:	706-549-9195
Fax Number	:	866-349-3527

Provider Business Practice Location Address
First Line	:	150 YONAH AVE
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30601-1740
Country	:	US
Telephone Number	:	706-549-9195
Fax Number	:	866-349-3527

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/08/2007

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