Individual
EDWARD C. MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
315 BOULEVARD NE, SUITE 444, ATLANTA, GA 30312-1200
(404) 420-0116
(404) 420-0117
Mailing address
P.O. BOX 370569, DECATUR, GA 30037
(678) 492-5985
(404) 420-0117
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
021754
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000203002D
—
GA
01
—
5729084
AETNA PROVIDER NUMBER
GA
Enumeration date
09/21/2006
Last updated
09/07/2011
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