Individual
DR. MARK ALAN CHASTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
835 COGBURN AVE NW, SUITE 100, MARIETTA, GA 30060-1031
(770) 422-5557
(770) 422-5456
Mailing address
835 COGBURN AVE NW, SUITE 100, MARIETTA, GA 30060-1031
(770) 422-5557
(770) 422-5456
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
048995
GA
207ND0101X
MOHS-Micrographic Surgery Physician
048995
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
339883816A
—
GA
01
—
P00086676
RAILROAD MEDICARE
GA
Enumeration date
02/01/2006
Last updated
06/12/2020
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