Provider Demographics
NPI:1164469979
Name:EPPS, MARK H (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:H
Last Name:EPPS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-494-3008
Practice Address - Street 1:2000 10TH AVE STE 270
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3706
Practice Address - Country:US
Practice Address - Phone:706-992-6590
Practice Address - Fax:706-992-6595
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004344363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicare ID - Type Unspecified
GAQ26504Medicare UPIN