Provider Demographics
NPI:1225146699
Name:SHOEMAKER, MARK MACGILLIVRAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MACGILLIVRAY
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2202
Mailing Address - Country:US
Mailing Address - Phone:229-439-9400
Mailing Address - Fax:229-436-3718
Practice Address - Street 1:406 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2202
Practice Address - Country:US
Practice Address - Phone:229-439-9400
Practice Address - Fax:229-436-3718
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029781207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA237601OtherBLUE CROSS BLUE SHIELD
GA237601OtherBLUE CROSS BLUE SHIELD