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Individual

MARK E BLANKENSHIP

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
594 S COLUMBIA AVE, STE 100, RINCON, GA 31326-0919
(912) 826-4057
(912) 826-2853
Mailing address
PO BOX 919, RINCON, GA 31326-0919
(912) 826-4057
(912) 826-2853

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
043557
GA
208C00000X
Colon & Rectal Surgery Physician
Primary
043557
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00791557A
GA
01
CN8505
RR MEDICARE
GA
Enumeration date
07/28/2005
Last updated
11/15/2007
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