Individual
MARK S WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1700 HOSPITAL SOUTH DR, SUITE 202, AUSTELL, GA 30106-6810
(770) 944-7818
(770) 944-6402
Mailing address
1700 HOSPITAL SOUTH DR, SUITE 202, AUSTELL, GA 30106-6810
(770) 944-7818
(770) 944-6402
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
032499
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000414939C
—
GA
Enumeration date
08/24/2006
Last updated
06/26/2015
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