Oliver, Mark Custodio
Oliver, Mark Custodio is an individual health care provider with primary practice located at 2416 Capstone Ct , Columbus GA 31909-2795. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Oliver, Mark Custodio can be contacted via phone (706) 327-1281.Contact Information
Primary practice address
2416 Capstone Ct
Columbus GA 31909-2795
Phone: (706) 327-1281
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 048557 | Georgia |
Profile Details
| NPI number | 1275649758 |
|---|---|
| LBN Legal business name | Oliver, Mark Custodio |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 21st, 2006 |
| Last updated | Mar 20th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275649758 | NPPES |
| Georgia | Other | 048557 | LICENSE NUMBER |
| Georgia | MEDICAID | 00867765A | LICENSE NUMBER |
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