Individual
DR. MARK J. GREENBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1835 SAVOY DR STE 200, ATLANTA, GA 30341-1073
(770) 279-2900
(770) 279-0351
Mailing address
1835 SAVOY DR STE 200, ATLANTA, GA 30341-1073
(770) 279-2900
(770) 279-0351
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
POD000611
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00412068A
—
GA
05
—
00412068C
—
GA
01
—
480020017
RR MEDICARE
GA
Enumeration date
05/19/2006
Last updated
01/31/2020
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