License holder summary

FANTAUZZI, MARK RUDOLPH, DO is a Medical - Physician licensed to practice in Georgia. The address on file for FANTAUZZI, MARK RUDOLPH, DO is 91 AUBURN STREET #J-1229 | C\O MEDLICENSURE PROF SVCS, LLC, PORTLAND 04103. This doctor license is not current. The license was granted 02/06/1997 and expired on 11/30/2012.

Georgia

Composite Medical Board

FANTAUZZI, MARK RUDOLPH, DO
Medical - Physician
License number
043202
Date granted
02/06/1997
Date expires
11/30/2012
Class
Medical - Physician
Status
Surrendered
Address
91 AUBURN STREET #J-1229 | C\O MEDLICENSURE PROF SVCS, LLC
georgiadoctors.net
ID 38041695
LAST UPDATED 2024-04-22 13:22:56 UTC

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