Provider Demographics
NPI:1912940990
Name:LAFFERTY, MARK A I (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:LAFFERTY
Suffix:I
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:233 N HOUSTON RD
Mailing Address - Street 2:SUITE 143 H
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3074
Mailing Address - Country:US
Mailing Address - Phone:478-923-2229
Mailing Address - Fax:888-456-6653
Practice Address - Street 1:233 N HOUSTON RD
Practice Address - Street 2:SUITE 143 H
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3074
Practice Address - Country:US
Practice Address - Phone:478-923-2229
Practice Address - Fax:888-456-6653
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2012-01-20
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Provider Licenses
StateLicense IDTaxonomies
GA035676207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00627305CMedicaid
GA00627305CMedicaid
GA16BDFPZMedicare PIN