Provider Demographics
NPI:1346340320
Name:MARK R HARVEY MD PC
Entity Type:Organization
Organization Name:MARK R HARVEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-552-0967
Mailing Address - Street 1:203 MEDICAL ARTS PL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082
Mailing Address - Country:US
Mailing Address - Phone:478-552-0967
Mailing Address - Fax:478-552-8541
Practice Address - Street 1:203 MEDICAL ARTS PL
Practice Address - Street 2:SUITE 3
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082
Practice Address - Country:US
Practice Address - Phone:478-552-0967
Practice Address - Fax:478-552-8541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00456079AMedicaid
GA11BDDDCMedicare ID - Type Unspecified
GA00456079AMedicaid