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Organization
MARK BYRON MD PC
Active
Organization
MARK BYRON MD PC
Active
Parent organization
MARK BYRON MD PC
Other names
wayne urology
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARK BYRON MD PC
Authorized official
MARK DANIEL BYRON M.D. (MD OWNER)
(912) 427-8033
Entity
Organization
Contact information
Practice address
162 MEMORIAL DR, JESUP, GA 31545-0101
(912) 427-8033
Mailing address
162 MEMORIAL DR, JESUP, GA 31545-0101
(912) 427-8033
(912) 427-7565
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
047579
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00833599B
—
GA
01
—
GRP 4653
MEDICARE GROUP NUMBER
GA
Enumeration date
09/13/2007
Last updated
01/26/2011
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