Organization
EDWARD C MACK M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD C MACK M.D. (PRESIDENT)
(404) 241-0103
Entity
Organization
Contact information
Practice address
2855 CANDLER RD, SUITE 06, DECATUR, GA 30034-1415
(404) 241-0103
(404) 241-0069
Mailing address
2855 CANDLER RD, SUITE 06, DECATUR, GA 30034-1415
(404) 241-0103
(404) 241-0069
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
Enumeration date
10/29/2013
Last updated
10/29/2013
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