Provider Demographics
NPI:1801859053
Name:SNYDER, MARK M (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:900 CIRCLE 75 PKWY.
Mailing Address - Street 2:STE. 900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3084
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:960 SANDERS RD.
Practice Address - Street 2:STE. 100
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5962
Practice Address - Country:US
Practice Address - Phone:770-889-9596
Practice Address - Fax:770-889-9547
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAGA001027213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA812123483OMedicaid
GA812123483OMedicaid
GAV05024Medicare UPIN
GA48SCCWTMedicare PIN
GA1103400017Medicare NSC