Provider Demographics
NPI:1356337448
Name:MARKS, WILLIAM PARKER JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PARKER
Last Name:MARKS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:125 OAKSIDE CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2498
Mailing Address - Country:US
Mailing Address - Phone:678-880-0662
Mailing Address - Fax:678-880-0675
Practice Address - Street 1:125 OAKSIDE CT
Practice Address - Street 2:SUITE 102
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2498
Practice Address - Country:US
Practice Address - Phone:678-880-0662
Practice Address - Fax:678-880-0675
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2010-07-14
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Provider Licenses
StateLicense IDTaxonomies
GA030829207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000575858JMedicaid
GAE84469Medicare UPIN
GA18BDGDFMedicare ID - Type Unspecified