Individual
MARK FOUTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1621 N ROBERTS RD NW STE 110, KENNESAW, GA 30144-3640
(770) 702-1806
Mailing address
1621 N ROBERTS RD NW STE 110, KENNESAW, GA 30144-3640
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
008183
GA
Other
Enumeration date
10/25/2016
Last updated
10/25/2016
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