DR. MARK R. LIGHT (NPI# 1427055805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427055805 |
| Entity Type | Individual |
| Full Name | DR. MARK R. LIGHT |
| Credential | DPM |
| Practice Address |
4439 Roswell Rd Marietta GA 30062-6452 |
| Practice Telephone | 7709778221 |
| Practice Fax Number | 7709778222 |
| Mailing Telephone | 7709778221 |
| Mailing Fax Number | 7709778222 |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2016-09-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
00630 | GA | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | DMERC | 4830810001 | 01 |
| GA | TAX ID # | 412063128 | 01 |
| GA | AETNA PPO | 4137290 | 01 |
| GA | 000467618B | 05 | |
| GA | AETNA HMO | 3026473 | 01 |
| GA | PEACHCARE MEDICARE | REF000049272 | 01 |
| GA | BCBS | 005480 | 01 |
| GA | RAILROAD MEDICARE | 480034802 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427053388 | Mark W Light | Family Medicine | 1279 E 1st Ave, Ste C, Chico, CA 95926-1542 | 2005-06-16 |
| 1770868259 | Mark Light | Physician Assistant | 800 Forest Ave, Zanesville, OH 43701-2882 | 2011-10-17 |
| Street Address |
4439 ROSWELL RD |
| City | MARIETTA |
| State | GA |
| Zip Code | 30062-6452 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184819930 | East Cobb Podiatry Surgery Center, LLC | Clinic/Center | 4439 Roswell Rd, Marietta, GA 30062-6452 | 2007-09-13 |
| 1184770133 | East Cobb Foot & Ankle Care P.C. | Podiatrist | 4439 Roswell Rd, Marietta, GA 30062-6452 | 2007-01-25 |
| 1053470732 | Robert I Heden | Podiatrist | 4439 Roswell Rd, Marietta, GA 30062-6452 | 2006-12-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619578051 | Pamela D Kretzmer | Social Worker | 3855 Shallowford Road, Suite 420, Marietta, GA 30062 | 2020-11-03 |
| 1932714680 | Michelle Chambless | Physical Therapist | Team Rehabilitation Ga01, LLC, 1401 Johnson Ferry Road, Suite 340, Marietta, GA 30062 | 2020-09-10 |
| 1700408887 | Life University | Chiropractor | 1323 Roswell Road, Marietta, GA 30062 | 2020-05-12 |
| 1104451160 | Sno Healthcare Group | Clinic/Center | 2424 Roswell Rd Ste 120, Marietta, GA 30062 | 2020-03-10 |
| 1811536212 | Sandy Plains Dental Group, PC | Dentist | 3460 Sandy Plains Rd, Suite 240, Marietta, GA 30062 | 2020-01-02 |
| 1073159034 | Magdala Tulcie Jodesty-jackson | Social Worker | 4343 Shalloword Road, Building H, Suite 4 Lower Level, Marietta, GA 30062 | 2019-11-25 |
| 1598235178 | Matthew Driggers | Counselor | 4343 Shallowford Rd C2, Marietta, GA 30062 | 2018-11-27 |
| 1750895785 | Emily Grace Minday | Counselor | 4343 Shallowford Road Building C, Suite 1 Lower Level, Marietta, GA 30062 | 2017-11-29 |
| 1477072122 | Jason Lee Amos | Speech-Language Pathologist | 3660 Chestnut Ridge Court, Marietta, GA 30062 | 2017-09-13 |
| 1346761376 | Marian Pomaah Opoku-agyeman | Nurse Practitioner | 4661 Andrea Pointe, Marietta, GA 30062 | 2017-06-29 |
| Find all providers in zip 30062 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194184879 | Sequioa Ducasse | Podiatrist | 2550 Windy Hill Rd Se Ste 206, Marietta, GA 30067-8654 | 2016-02-23 |
| 1578946745 | Neha Delvadia | Podiatrist | 3901 Roswell Rd Ste 340, Marietta, GA 30062-6250 | 2015-07-06 |
| 1447653761 | Marie-christine Bergeron | Podiatrist | 3225 Shallowford Rd Ste 200, Marietta, GA 30062-1288 | 2014-10-01 |
| 1578856902 | Irene Cristina Verlezza | Podiatrist | 1200 Johnson Ferry Rd Ste 150, Marietta, GA 30068-5403 | 2011-05-18 |
| 1811019730 | Vivian Chizorom Iwu | Podiatrist | 540 Powder Springs St Ste B6, Marietta, GA 30064-3559 | 2007-04-03 |
| 1700981057 | Nathan Harold Schwartz | Podiatrist | 792 Church St Ne Ste 102, Marietta, GA 30060 | 2006-09-13 |
| 1497740229 | Mathew M. John | Podiatrist | 2790 Sandy Plains Rd, Suite 300, Marietta, GA 30066-4378 | 2005-09-19 |
| 1043827280 | Choice Podiatry Center, Inc. | Podiatrist | 540 Powder Springs St Ste B6, Marietta, GA 30064-3559 | 2020-09-30 |
| 1730721408 | Krishna Podiatry Group of Georgia | Podiatrist | 3901 Roswell Rd Ste 340, Marietta, GA 30062-6250 | 2019-10-14 |
| 1417342700 | Matthew Ward | Podiatrist | 165 Vann St Ne, Marietta, GA 30060 | 2015-04-02 |
| Find all providers in MARIETTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.