Active NPI
Kenneth Jay Marks, DO
- Psychiatry Physician
- Milledgeville, GA
National Provider Identifier
1982675468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 035293
- Practice address
- 131 N Jefferson St NE
Milledgeville, GA 31061-5513 - Phone
- (478) 445-4817
- Fax
- (478) 445-4817
- NPI assigned
- Jan 31, 2006
- Last updated
- Aug 31, 2009
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 035293 | GA | Primary |
Addresses
Primary practice location
131 N Jefferson St NE
Milledgeville, GA 31061-5513
Mailing address
131 N Jefferson St NE
Milledgeville, GA 31061-5513
Phone (478) 445-4817
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GRP1997 | Other | GA | MEDICARE ORGANIZATION PTAN |
| GRP2030 | Other | GA | MEDICARE ORGANIZATION PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fulton County Mhddad | Past | Accepting new patients | |
| Oconee Community Service Board | Past | Accepting new patients | |
| Fulton County Mental Health Center | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Atlanta, GA
- NPI 1437299625
-
dba West Mental Health Center
- Community/Behavioral Health Agency
- Atlanta, GA
- NPI 1285700682
-
- Community/Behavioral Health Agency
- Milledgeville, GA
- NPI 1295922128
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251676800000",
"number": "1982675468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "131 N JEFFERSON ST NE",
"city": "MILLEDGEVILLE",
"state": "GA",
"postal_code": "310615513",
"telephone_number": "478-445-4817",
"fax_number": "478-445-0963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "131 N JEFFERSON ST NE",
"city": "MILLEDGEVILLE",
"state": "GA",
"postal_code": "310615513",
"telephone_number": "478-445-4817",
"fax_number": "478-445-4817"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARKS",
"first_name": "KENNETH",
"middle_name": "JAY",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-31",
"last_updated": "2009-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "GA",
"license": "035293",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ORGANIZATION PTAN",
"identifier": "GRP1997",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ORGANIZATION PTAN",
"identifier": "GRP2030",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milledgeville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.