Individual
LENA A MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAAA
Contact information
Practice address
2540 WINDY HILL RD SE, MARIETTA, GA 30067-8605
(770) 644-1274
Mailing address
PO BOX 155, AUSTELL, GA 30168-1002
(770) 732-3649
(770) 732-3648
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
003507
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096995311A
—
GA
Enumeration date
04/08/2006
Last updated
10/29/2019
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