Provider Demographics
NPI:1396854394
Name:MARKS, GEORGIANNA K (PHD, APRN, PC)
Entity type:Individual
Prefix:MS
First Name:GEORGIANNA
Middle Name:K
Last Name:MARKS
Suffix:
Gender:F
Credentials:PHD, APRN, PC
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Mailing Address - Street 1:14 CUSHING AVE
Mailing Address - Street 2:ST MARY'S CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02125
Mailing Address - Country:US
Mailing Address - Phone:857-230-0983
Mailing Address - Fax:866-610-6501
Practice Address - Street 1:14 CUSHING AVE
Practice Address - Street 2:ST MARY'S CHURCH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02125
Practice Address - Country:US
Practice Address - Phone:857-230-0983
Practice Address - Fax:866-610-6501
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA124796364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA NS0096Medicare ID - Type Unspecified