NPI 1073555629

L Mark Gustafson, MD

Practitioner Otolaryngology Physician Carrollton, GA

Practice location

Address: 150 Clinic Ave Suite 201, Carrollton, GA 30117-4401
Phone: (770) 832-1488

Registered specialties

Otolaryngology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Y00000X Licence 049795 (GA)

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Registry record

NPI: 1073555629
Entity type: Individual
Sex (as registered): Male
NPI issued: 11 Jun 2006
Record last updated: 18 Jul 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.