Provider Demographics
NPI:1902143407
Name:BEIRNE, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:BEIRNE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4375 OAKDALE VININGS CIR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6982
Mailing Address - Country:US
Mailing Address - Phone:770-223-9677
Mailing Address - Fax:770-319-9215
Practice Address - Street 1:4375 OAKDALE VININGS CIR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6982
Practice Address - Country:US
Practice Address - Phone:770-223-9677
Practice Address - Fax:770-319-9215
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA068846208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice