Individual
MARK VAKKUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2200 CENTURY PKWY NE, SUITE 200, ATLANTA, GA 30345-3154
(404) 486-7450
(404) 325-3663
Mailing address
1751 VICKERS CIR, DECATUR, GA 30030-1033
(404) 486-7450
(404) 325-3663
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
47548
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00976302A
—
GA
Enumeration date
07/27/2006
Last updated
07/08/2007
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