Provider Demographics
NPI:1861697468
Name:MARK SHOPTAUGH, PLLC
Entity type:Organization
Organization Name:MARK SHOPTAUGH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOPTAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-938-7253
Mailing Address - Street 1:PO BOX 70097
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30007-0097
Mailing Address - Country:US
Mailing Address - Phone:770-578-1800
Mailing Address - Fax:
Practice Address - Street 1:190 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28741-7600
Practice Address - Country:US
Practice Address - Phone:828-526-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty