Provider Demographics
NPI:1053334383
Name:HOWELL, MARY R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:R
Last Name:HOWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-2353
Mailing Address - Country:US
Mailing Address - Phone:229-896-1510
Mailing Address - Fax:229-896-1514
Practice Address - Street 1:308 N PARRISH AVE
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-2353
Practice Address - Country:US
Practice Address - Phone:229-896-1510
Practice Address - Fax:229-896-1514
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035658174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA160057800OtherRR MEDICARE
GA00616811DMedicaid
GA160057800OtherRR MEDICARE
GA00616811DMedicaid