Individual
MARK C ANKROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.A.
Contact information
Practice address
1700 MEDICAL WAY, SNELLVILLE, GA 30078-2195
(770) 979-9996
Mailing address
PO BOX 3559, SUWANEE, GA 30024-0993
(770) 979-9996
(770) 979-1202
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
001063
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000329A
—
GA
01
—
970003876
RAILROAD MEDICARE
GA
Enumeration date
11/21/2005
Last updated
06/24/2010
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