Individual provider Active NPI

Mark G Hanly, MBCHB, FRCPATHLOND

  • Anatomic Pathology & Clinical Pathology Physician
  • Brunswick, GA
National Provider Identifier
1619951258
Registry record updated Aug 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
035181 Issued in GA
Practice address
203 Indigo Dr
Brunswick, GA 31525-6865
Phone
(912) 261-2669
Fax
(912) 261-0561
NPI assigned
Dec 6, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 035181 GA Primary

Addresses

Primary practice location

203 Indigo Dr
Brunswick, GA 31525-6865

Mailing address

PO Box 30309
Charleston, SC 29417-0309
Phone (843) 554-9300

Other identifiers 1

IdentifierTypeStateIssuer
000638206BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC, FL3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20100520000757 GA Practitioner - Pathology 0840286324 Reassigns benefits to 1 organization
I20120119000915 SC Practitioner - Pathology 0840286324 Reassigns benefits to 1 organization
I20130606000620 FL Practitioner - Pathology 0840286324 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
035181GAMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Pathology Associates PC Anatomic Pathology & Clinical Pathology CurrentSince Jul 1, 2007 Accepting new patients
Southeastern Pathology Associates PC Anatomic Pathology & Clinical Pathology CurrentSince Apr 25, 2011 Accepting new patients
Coastal Care Inc Past Accepting new patients
Southeastern Pathology Associates at Wayne Memorial Inc Anatomic Pathology & Clinical Pathology PastSince Jan 1, 1991 Accepting new patients

Locations (25 of 26)

1250 S 18th St
Fernandina Beach, FL 32034
Phone (904) 202-2087

801 Oak St
Green Cv Spgs, FL 32043
Phone (904) 215-7015

14550 Old St Augustine Rd
Jacksonville, FL 32258
Phone (904) 202-5010

800 Prudential Dr
Jacksonville, FL 32207
Phone (904) 202-2000

1350 13th Ave S
Jax Bch, FL 32250
Phone (904) 247-2900

163 E Tollison St
Baxley, GA 31513
Phone (912) 367-9847

203 Indigo Dr
Brunswick, GA 31525
Phone (912) 279-1900

3215 Shrine Rd
Ste 2
Brunswick, GA 31520
Phone (912) 262-0042

2415 Parkwood Dr
Brunswick, GA 31520
Phone (912) 466-4079

616 19th St
Columbus, GA 31901
Phone (706) 494-4262

710 Center St
Columbus, GA 31901
Phone (706) 571-1000

1101 Ocilla Rd
Douglas, GA 31533
Phone (912) 383-5641

163 S Tallahassee St
Hazlehurst, GA 31539
Phone (912) 375-7781

865 S 1st St
Jesup, GA 31545
Phone (912) 427-6811

821 N Cobb St
Milledgeville, GA 31061
Phone (478) 454-3500

898 College St
Monticello, GA 31064
Phone (706) 468-0988

2000 Dan Proctor Dr
Saint Marys, GA 31558
Phone (912) 576-6160

900 Mohawk St
Ste C
Savannah, GA 31419
Phone (912) 927-9715

459 Highway 119 S
Springfield, GA 31329
Phone (912) 754-0200

1499 Fair Rd
Statesboro, GA 30458
Phone (912) 486-1000

801 W Gordon St
Thomaston, GA 30286
Phone (706) 647-4371

2810 N Oak St
Valdosta, GA 31602
Phone (229) 259-0019

1 Meadows Pkwy
Vidalia, GA 30474
Phone (912) 535-5429

1601 Watson Blvd
Warner Robins, GA 31093
Phone (478) 322-5155

2005 Pioneer St
Ste B
Waycross, GA 31501
Phone (912) 285-8822

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314662400000",
    "number": "1619951258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30309",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294170309",
            "telephone_number": "843-554-9300",
            "fax_number": "843-566-8780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 INDIGO DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315256865",
            "telephone_number": "912-261-2669",
            "fax_number": "912-261-0561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANLY",
        "first_name": "MARK",
        "middle_name": "G",
        "credential": "MBCHB, FRCPATHLOND",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-06",
        "last_updated": "2011-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "GA",
            "license": "035181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000638206B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, GA

Sources for this page

Verify at the official NPI Registry.