Provider Demographics
NPI:1508043829
Name:MARK, NJE SERETSE (MD)
Entity Type:Individual
Prefix:DR
First Name:NJE
Middle Name:SERETSE
Last Name:MARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5410 MARYLAND WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-371-5765
Mailing Address - Fax:888-241-1404
Practice Address - Street 1:777 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2102
Practice Address - Country:US
Practice Address - Phone:478-633-7550
Practice Address - Fax:478-633-3235
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2010-02-10
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Provider Licenses
StateLicense IDTaxonomies
GA002082207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002082OtherEMORY SCHOOL OF MEDICINE
GA002082OtherEMORY SCHOOL OF MEDICINE