Provider Demographics
NPI:1831268630
Name:HEBERT, MARK G (NP-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:HEBERT
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2140 PEACHTREE RD NW STE 232
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1316
Mailing Address - Country:US
Mailing Address - Phone:404-231-4431
Mailing Address - Fax:404-231-5677
Practice Address - Street 1:2140 PEACHTREE RD NW
Practice Address - Street 2:SUITE 232
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1314
Practice Address - Country:US
Practice Address - Phone:404-231-4431
Practice Address - Fax:404-231-5677
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN116170363L00000X
GARN116170 NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA702601976AMedicaid
GA208628511AMedicaid
GA208628511AMedicaid