Provider Demographics
NPI:1437131596
Name:PARADELA, MARK JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JEROME
Last Name:PARADELA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1500 OGLETHORPE AVE
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2179
Mailing Address - Country:US
Mailing Address - Phone:706-549-8931
Mailing Address - Fax:706-549-0088
Practice Address - Street 1:1500 OGLETHORPE AVE
Practice Address - Street 2:SUITE 3200
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2179
Practice Address - Country:US
Practice Address - Phone:706-549-8931
Practice Address - Fax:706-549-0088
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2008-09-24
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Provider Licenses
StateLicense IDTaxonomies
GA049200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000937736DMedicaid
GAH46858Medicare UPIN