Provider Demographics
NPI:1174558191
Name:CAIN, MARK LENON (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:LENON
Last Name:CAIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4350 TOWNE CENTRE DR STE 2200
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3301
Mailing Address - Country:US
Mailing Address - Phone:706-722-0705
Mailing Address - Fax:762-333-0496
Practice Address - Street 1:4350 TOWNE CENTRE DR STE 2200
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3301
Practice Address - Country:US
Practice Address - Phone:706-722-0705
Practice Address - Fax:762-333-0496
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-03-30
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Provider Licenses
StateLicense IDTaxonomies
GA35020208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00597594AMedicaid
GA00597594AMedicaid
F76387Medicare UPIN