# VASCULAR INSTITUTE OF GEORGIA, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Vascular Insitute of Georiga, PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932167269
- **Authorized official:** MR. MARK J MITTENTHAL M.D. (PHYSICIAN)
- **Authorized official phone:** (404) 256-0404

## Contact information

- **Practice address:** 5669 PEACHTREE DUNWOODY RD NE, SUITE 100, ATLANTA, GA 30342-1786
- **Practice address phone:** (404) 256-0404
- **Practice address fax:** (404) 847-0423
- **Mailing address:** 5669 PEACHTREE DUNWOODY RD NE, SUITE 100, ATLANTA, GA 30342-1786
- **Mailing address phone:** (404) 256-0404
- **Mailing address fax:** (404) 847-0423

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/03/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00206005I | — | GA |
| 05 | — | 00216466H | — | GA |
| 05 | — | 00460039E | — | GA |
| 01 | — | 1033184767 | J. MARK RHEUDASIL | GA |
| 01 | — | 1376517300 | ALAN KOORNICK | GA |
| 01 | — | 1528028925 | MICHAEL D. CLARK | GA |
| 01 | — | 1598739559 | MARK MITTENTHAL | GA |
| 01 | — | 1629038476 | PETER H'DOUBLER JR. | GA |
| 01 | — | 1861466955 | MARK G. COAN | GA |