Individual
MARK M NOVOTNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
535 JESSE JEWELL PKWY SE, SUITE C, GAINESVILLE, GA 30501-3772
(770) 534-1711
Mailing address
535 JESSE JEWELL PKWY SE, SUITE C, GAINESVILLE, GA 30501-3772
(770) 534-1711
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT001945
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00922501A
—
GA
Enumeration date
12/14/2006
Last updated
07/08/2007
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