Stevens, Mark R
Stevens, Mark R is an individual health care provider with primary practice located at 1430 John Wesley Gilbert Drive , Augusta GA 30912-0004. He recently has only one registered license in Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery, which is considered as his primary health care specialty. Stevens, Mark R can be contacted via phone (706) 721-9744.Contact Information
Primary practice address
1430 John Wesley Gilbert Drive
Augusta GA 30912-0004
Phone: (706) 721-9744
Fax: (706) 721-6778
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery | 204E00000X | DN7757 | Florida |
| Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery | 204E00000X | DNGA000215 | Georgia |
| Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery | 204E00000X | DDS25997 | California |
| Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery | 204E00000X | DN013387 | Georgia |
Profile Details
| NPI number | 1407878606 |
|---|---|
| LBN Legal business name | Stevens, Mark R |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 24th, 2006 |
| Last updated | Mar 22nd, 2021 - about 4 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 | 1407878606 | NPPES |
| Georgia | MEDICAID | 589724798B | |
| Georgia | MEDICAID | 589724798I | |
| Georgia | MEDICAID | ZG3387 |
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