Provider Demographics
NPI:1407291024
Name:PLEASANTS, MARK ARTHUR (CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ARTHUR
Last Name:PLEASANTS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1858
Mailing Address - Country:US
Mailing Address - Phone:229-242-3002
Mailing Address - Fax:229-242-0644
Practice Address - Street 1:230 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1858
Practice Address - Country:US
Practice Address - Phone:229-242-3002
Practice Address - Fax:229-242-0644
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN074931367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA43ZCCCH01Medicare PIN