Provider Demographics
NPI:1801878210
Name:IVEY, MARK H (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:IVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:308 STATHAMS WAY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7521
Mailing Address - Country:US
Mailing Address - Phone:478-929-4839
Mailing Address - Fax:
Practice Address - Street 1:320 MARGIE DRIVE
Practice Address - Street 2:HEART OF GEORGIA MEDICAL ASSOCIATES
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7817
Practice Address - Country:US
Practice Address - Phone:478-953-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-19
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0501062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology