Provider Demographics
NPI:1891737441
Name:SPARKES, MARY L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
Last Name:SPARKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EXECUTIVE CIR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3345
Mailing Address - Country:US
Mailing Address - Phone:912-355-2400
Mailing Address - Fax:912-355-5324
Practice Address - Street 1:5 EXECUTIVE CIR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3345
Practice Address - Country:US
Practice Address - Phone:912-355-2400
Practice Address - Fax:912-355-5324
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038102207Q00000X, 207P00000X
SC27316207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000591313KMedicaid
GA10058953OtherAMERIGROUP
GA000591313Medicaid
SCG38102Medicaid
GA000591313BMedicaid
GA000591313MMedicaid
GA000591313CMedicaid
GA000591313FMedicaid
SCF284498055Medicaid
GA000591313DMedicaid
SC000591313LMedicaid
GA000591313KMedicaid
F28449Medicare UPIN
GA000591313MMedicaid
GA930069217Medicare PIN
GA000591313CMedicaid
GA000591313DMedicaid
GA000591313Medicaid
GA930116786Medicare PIN