Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN015867 | GA |
Y | 213EG0000X | General Practice | DN015867 | GA |
NPI | 1003461294 |
---|---|
Provider Name | Mark William Oxley |
First Address | Vidalia, GA 30475-0406 |
Second Address | Vidalia, GA 30474-8914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2019 |
Last Update Date | 03/11/2019 |