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Individual
PROF. JOHN MARK LIDELL
Active
Individual
PROF. JOHN MARK LIDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.M.SC. , PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002952
GA
Other
Enumeration date
12/07/2005
Last updated
10/27/2021
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