Active NPI
Mark G Hanly, MBCHB, FRCPATHLOND
- Anatomic Pathology & Clinical Pathology Physician
- Brunswick, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 035181
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000638206B | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA, SC, FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 3
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 035181 | GA | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeastern Pathology Associates PC | Anatomic Pathology & Clinical Pathology | Current | Accepting new patients |
| Southeastern Pathology Associates PC | Anatomic Pathology & Clinical Pathology | Current | Accepting new patients |
| Coastal Care Inc | Past | Accepting new patients | |
| Southeastern Pathology Associates at Wayne Memorial Inc | Anatomic Pathology & Clinical Pathology | Past | 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.
-
- Anatomic Pathology & Clinical Pathology Physician
- Brunswick, GA
- NPI 1821104704
SC
-
- Anatomic Pathology & Clinical Pathology Physician
- Brunswick, GA
- NPI 1992963268
FL
-
- Primary Care Clinic/Center
- Waycross, GA
- NPI 1538367149
-
- Anatomic Pathology Physician
- Jesup, GA
- NPI 1043326861
Anatomic Pathology & Clinical Pathology
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.