Provider Demographics
NPI:1407882459
Name:STERN, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:STERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2675 N DECATUR RD
Mailing Address - Street 2:SUITE 506
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6131
Mailing Address - Country:US
Mailing Address - Phone:404-299-1679
Mailing Address - Fax:404-508-7694
Practice Address - Street 1:2675 N DECATUR RD
Practice Address - Street 2:SUITE 506
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6131
Practice Address - Country:US
Practice Address - Phone:404-299-1679
Practice Address - Fax:404-508-7694
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA38624207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00828022AMedicaid
GAG98427Medicare UPIN
GA00828022AMedicaid