L Mark Gustafson M.D.

NPI 1073555629 - Otolaryngology - 207Y00000X

NPI Details
NPI 1073555629
Gender Male
Enumeration Date 06/11/2006
Last Updated 09/21/2009
Entity Type Individual
Active Over 10 years ago
Practice Location
150 CLINIC AVE
SUITE 201
CARROLLTON GA, 30117-4401, US
Phone (770) 832-1488
Fax
Business Location
150 CLINIC AVE
SUITE 201
CARROLLTON GA, 30117-4401, US
Phone (770) 832-1488
Fax
Toxanomy
Taxonomy Code 207Y00000X
License State Georgia
License Number 049795
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According to our database, L Mark Gustafson M.D. NPI is 1073555629, taxonomy code is 207Y00000X and license number is 049795, license state is located at Georgia. L Mark Gustafson M.D. physically located at 150 Clinic Ave, Carrollton GA, 30117-4401. NPI Number L Mark Gustafson M.D. has the Individual type.

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1073555629 NPI number is provided on an as is basis without warranty of any kind. 1073555629 is maintained by the National Plan & Provider Enumeration System. The contents of L Mark Gustafson M.D. are for informational purposes only.