Grossnickle, Mark Earl

Grossnickle, Mark Earl is an individual health care provider with primary practice located at 770 Pine St Ste 290 Attn: Radiology Department, Macon GA 31201-7516. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Grossnickle, Mark Earl can be contacted via phone (478) 743-1458.

Contact Information

Primary practice address
770 Pine St Ste 290 Attn: Radiology Department Macon GA 31201-7516
Phone: (478) 743-1458
Fax: (478) 755-1332
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 35435 Georgia

Profile Details

NPI number 1942281076
LBN Legal business name Grossnickle, Mark Earl
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 7th, 2005
Last updated Jul 3rd, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942281076 NPPES
Georgia MEDICAID 000542924C

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