Individual
DR. MARIO DEAUNDRA INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
743 SPRING ST NE, GAINESVILLE, GA 30501-3715
(770) 219-9000
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
061093
GA
208M00000X
Hospitalist Physician
Primary
61093
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
095225920C
—
GA
05
—
095225920D
—
GA
Enumeration date
07/23/2007
Last updated
10/07/2020
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