Individual
MARK RUSSELL LING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
710 NEWNAN CROSSING BYPASS, SUITE A, NEWNAN, GA 30263-2321
(770) 251-5111
(770) 254-8680
Mailing address
7300 RANCH ROAD 2222, BUILDING 1, STE 200, AUSTIN, TX 78730
(512) 628-0465
(512) 233-2711
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
034647
GA
207NS0135X
Procedural Dermatology Physician
Primary
034647
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00469246C
—
GA
01
—
0390142
UHC
GA
01
—
070012632
RAIL ROAD MEDICARE
GA
01
—
2117569
AETNA HMO
GA
01
—
4279563008
CIGNA HMO
GA
01
—
4318069
AETNA NON-HMO
GA
Enumeration date
12/02/2005
Last updated
03/31/2023
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