Provider Demographics
NPI:1225230568
Name:BRINSON, MARK THOMAS (DOM,AP,CNMT)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:BRINSON
Suffix:
Gender:M
Credentials:DOM,AP,CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2481 DEMERE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-1601
Mailing Address - Country:US
Mailing Address - Phone:727-642-3924
Mailing Address - Fax:912-268-6002
Practice Address - Street 1:2481 DEMERE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-1601
Practice Address - Country:US
Practice Address - Phone:727-642-3924
Practice Address - Fax:912-268-6002
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1382171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist