Organization
MARK G BODDY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REGINA KIRKLAND (OFFICE MANAGER)
(478) 738-0404
Entity
Organization
Contact information
Practice address
840 PINE ST, SUITE 990, MACON, GA 31201-2100
(478) 738-0404
(478) 738-0805
Mailing address
840 PINE ST, SUITE 990, MACON, GA 31201-2100
(478) 738-0404
(478) 738-0805
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
032519
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP3233
GROUP
GA
Enumeration date
05/15/2008
Last updated
06/09/2008
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