Guerdan, Mark Carroll
Guerdan, Mark Carroll is an sole proprietor health care provider with primary practice located at 6525 Professional Pl Suite B, Riverdale GA 30274-2519. He recently has 4 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Interventional Pain Medicine. Allopathic & Osteopathic Physicians / Anesthesiology is his primary health care specialty. Guerdan, Mark Carroll can be contacted via phone (404) 254-5496.Contact Information
Primary practice address
6525 Professional Pl Suite B
Riverdale GA 30274-2519
Phone: (404) 254-5496
Fax: (404) 254-5829
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing Service Providers / Registered Nurse | 163W00000X | 31403 | Kentucky |
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 62257 | New York |
| Allopathic & Osteopathic Physicians / Pain Medicine | 207LP2900X | 061081 | Georgia |
| Allopathic & Osteopathic Physicians / Interventional Pain Medicine | 208VP0014X | 061081 | Georgia |
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 61081 | Georgia |
| Allopathic & Osteopathic Physicians / Pain Medicine | 208VP0000X | 61081 | Georgia |
| Allopathic & Osteopathic Physicians / Pain Medicine | 207LP2900X | 61081 | Georgia |
Profile Details
| NPI number | 1326089574 |
|---|---|
| LBN Legal business name | Guerdan, Mark Carroll |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 9th, 2006 |
| Last updated | Jul 14th, 2014 - about 10 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1326089574 | NPPES |
| Georgia | MEDICAID | 003135346A | |
| Georgia | MEDICAID | 003135345A |
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