Provider Demographics
NPI:1962480889
Name:MAYSON, MARK JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JAMES
Last Name:MAYSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-3273
Mailing Address - Fax:803-296-7061
Practice Address - Street 1:1333 TAYLOR ST
Practice Address - Street 2:SUITE 4-G
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2923
Practice Address - Country:US
Practice Address - Phone:803-296-3273
Practice Address - Fax:803-296-7061
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2021-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC15931207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC159312Medicaid
SCF089605771OtherMEDICARE PTAN
SC159312Medicaid