Individual
VAN MAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
341 PONCE DE LEON AVE NE, ATLANTA, GA 30308-2012
(404) 616-1000
Mailing address
225 WEMBLEY CIR, ATLANTA, GA 30328-6758
Taxonomy
Speciality
Code
Description
License number
State
1835I0206X
Infectious Diseases Pharmacist
Primary
RPH024620
GA
Other
Enumeration date
03/11/2026
Last updated
03/11/2026
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