Provider Demographics
NPI:1609038272
Name:AHLMAN, MARK ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLAN
Last Name:AHLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1120 15TH ST # OR6000
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-446-5941
Mailing Address - Fax:706-721-9286
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-9104
Practice Address - Country:US
Practice Address - Phone:706-721-8623
Practice Address - Fax:706-721-1459
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2022-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCLL31029207Q00000X
GA93832207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8495OtherAMERICAN BOARD OF NUCLEAR MEDICINE, INC.