NPI age
19 years
Enumerated 2006-06-11
● Active
Type 1 · Individual
L Mark Gustafson, M.D.
Gustafson is 1 of 6 otolaryngology providers in Carrollton and 1 of 450 in Georgia.
Primary specialty
Otolaryngology
Licensed in
GA
1 state
Status
Active
No deactivations on record
Last NPPES update
2022-07-18
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 450 active otolaryngology providers in Georgia.
NPI age
19 years
≈ at median (19 yr)
State licenses
1 state
12% of peers hold multiple states
Subspecialties
0
30% of peers hold subspecialties
NPI lifetime · 2006 → 2026
2006-06Enumerated in NPPES
2006
2026
Where they practice
Practice location
150 Clinic Ave, Suite 201
Carrollton, GA 301174401
Mailing address
150 Clinic Ave, Suite 201
Carrollton, GA 301174401
Specialties
-
Otolaryngology PrimaryAn otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (GA) | 841043 | BLUE CROSS CLUE SHIELD |
| 05 (GA) | 00906463C | |
| 05 (GA) | 00906463B |
Practice context
Part of a multi-provider practice. 30 other active providers share this practice address in NPPES.
Provyx · Custom healthcare lists
Need all 450 Otolaryngology providers in Georgia?
Get the full list as a CSV with verified work emails, direct phones, and LinkedIn URLs.
Request a quote →How to verify this provider
- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.