Provider Demographics
NPI:1407029382
Name:HANCOCK, MARK JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:135 MAPLE ST
Mailing Address - Street 2:BLDG A
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3953
Mailing Address - Country:US
Mailing Address - Phone:706-297-1510
Mailing Address - Fax:470-575-2575
Practice Address - Street 1:135 MAPLE ST
Practice Address - Street 2:BLDG A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3953
Practice Address - Country:US
Practice Address - Phone:706-297-1510
Practice Address - Fax:470-575-2575
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2022-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA67750207Q00000X
NMMD2010-0138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine