Individual
MARK J. MITTENTHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5669 PEACHTREE DUNWOODY RD, SUITE 100, ATLANTA, GA 30342-1786
(404) 256-0404
(404) 847-0423
Mailing address
1838 AMERICAN WAY, LAWRENCEVILLE, GA 30043-6611
(770) 995-7622
(770) 995-7854
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
017864
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000206005
—
GA
Enumeration date
02/15/2006
Last updated
08/23/2011
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