Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 041421 | GA |
Y | 111NI0900X | Internist | 041421 | GA |
NPI | 1003801895 |
---|---|
Provider Name | Dr. Mark P Crick |
First Address | Statesboro, GA 30458-0854 |
Second Address | Statesboro, GA 30458 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2005 |
Last Update Date | 17/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000750329B | (05) | GA |
G54468 | (02) | GA |