Provider Demographics
NPI:1487776506
Name:HESSENTHALER, MARK ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ERIC
Last Name:HESSENTHALER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:360 POST ST
Mailing Address - Street 2:STE 500
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4908
Mailing Address - Country:US
Mailing Address - Phone:415-671-6819
Mailing Address - Fax:415-539-3239
Practice Address - Street 1:300 W HOSPITAL RD
Practice Address - Street 2:DDEAMC, BEHAVIOR HEALTH, 13TH FLOOR
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-829-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC1548752084P0800X, 2084P0800X
GA702932084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry