# MARK BYRON MD PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MARK BYRON MD PC
- **Other names:** wayne urology
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1063607828
- **Legal business name:** MARK BYRON MD PC
- **Authorized official:** MARK DANIEL BYRON M.D. (MD OWNER)
- **Authorized official phone:** (912) 427-8033

## Contact information

- **Practice address:** 162 MEMORIAL DR, JESUP, GA 31545-0101
- **Practice address phone:** (912) 427-8033
- **Mailing address:** 162 MEMORIAL DR, JESUP, GA 31545-0101
- **Mailing address phone:** (912) 427-8033
- **Mailing address fax:** (912) 427-7565

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 047579 | GA | Yes |

## Other

- **Enumeration date:** 09/13/2007
- **Last updated:** 01/26/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00833599B | — | GA |
| 01 | — | GRP 4653 | MEDICARE GROUP NUMBER | GA |