Individual
MARY STREET LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
801 W GORDON ST, THOMASTON, GA 30286-3426
(706) 647-8111
(706) 647-4389
Mailing address
PO BOX 589, THOMASTON, GA 30286-0008
(706) 647-8111
(706) 647-4389
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
040466
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183893252B
—
GA
01
—
925994
BLUE CROSS BLUE SHIELD
—
01
—
P00144203
RAILROAD MEDICARE
—
Enumeration date
08/26/2005
Last updated
03/03/2010
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us