Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

L Mark Gustafson, MD

Individual provider Otolaryngology Physician · NPI 1073555629

L Mark Gustafson, MD is an Otolaryngology in Carrollton, Georgia. Qualified in 1996, 30 years ago. Practices with Tanner Medical Group Inc, a 120-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
30
Licensed in
GA
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

150 Clinic Ave Ste 201
Carrollton, GA 30117-4401
Phone: (770) 832-1488
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Otolaryngology Physician (primary) Taxonomy 207Y00000X · Licence 049795 (GA)

Record details

NPI number1073555629
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 11, 2006
Last updated in NPPESJuly 18, 2022
Certification dateJuly 18, 2022
Mailing address150 Clinic Ave, Suite 201, Carrollton, GA 30117-4401

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOTOLARYNGOLOGY
Medical schoolOTHER
Graduated 1996 (30 years in practice)
Group practice Tanner Medical Group Inc — 120 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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