Individual
MARC MITCHELL DYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1035 RED BUD RD NE, CALHOUN, GA 30701-6008
(706) 879-4776
(706) 879-5841
Mailing address
PO BOX 12938, C/O CLINIC MANAGEMENT, CALHOUN, GA 30703
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN096589
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000550877J
—
GA
05
—
000550877K
—
GA
Enumeration date
07/02/2006
Last updated
12/20/2018
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