Provider Demographics
NPI:1275577934
Name:DOROGY, MARK E (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:DOROGY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:612 W GORDON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3480
Mailing Address - Country:US
Mailing Address - Phone:706-646-5712
Mailing Address - Fax:706-647-5111
Practice Address - Street 1:612 W GORDON ST
Practice Address - Street 2:SUITE C
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3480
Practice Address - Country:US
Practice Address - Phone:706-646-5712
Practice Address - Fax:706-647-5111
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA041105207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000692755AMedicaid
GA06BDFFGMedicare ID - Type Unspecified
GA000692755AMedicaid