Male or Other

L M. Gustafson M.D.

Otolaryngology Physician in Carrollton, GA(View on Map)

Full Name

L Mark Gustafson M.D.

NPI Number

1073555629

NPI Type

Individual Provider

Gender

Male

Enumeration Date

06/11/2006

Specialties

(Taxonomies)

Code

207Y00000X

Primary Taxonomy

Yes

Licenses

State

Georgia

License Number

049795

Contact
Information

Purpose

Mailing
Location

Address

150 CLINIC AVE
150 CLINIC AVE

City

Carrollton
Carrollton

State

GA
GA

Postal Code

30117-4401
30117-4401

Country

US
US

Telephone Number

(770) 832-1488
(770) 832-1488

Identifiers

Identifier

841043
00906463C
00906463B

Identifier State

GA
GA
GA

Identifier Issuer

BLUE CROSS CLUE SHIELD
Unknown
Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 07/18/2022

Provider Address

Other Otolaryngology Physicians in Carrollton, Georgia:

Male or Other

John Pezold M.D.

Carrollton, GA

Specialty: Otolaryngology Physician (Primary)

Male or Other

William Gambrell M.D.

Carrollton, GA

Specialty: Otolaryngology Physician (Primary)

Male or Other

Christopher Harper MD

Carrollton, GA

Specialties: Otolaryngology Physician (Primary)Student in an Organized Health Care Education/Training Program

Male or Other

Thomas Comstock M.D.

Carrollton, GA

Specialties: Otolaryngology Physician (Primary)General Practice PhysicianOccupational Medicine Physician