Provider Demographics
NPI:1083925622
Name:BANKS, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:BANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1945 E 70TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5347
Mailing Address - Country:US
Mailing Address - Phone:318-797-1743
Mailing Address - Fax:706-721-7599
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:BIW-2144
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-4544
Practice Address - Fax:706-721-7753
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
GA72858207L00000X
LA301220207L00000X
GA072858207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program