Individual
DR. MARK BANOV
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2151A IDLEWOOD RD, TUCKER, GA 30084-4816
(770) 270-1622
Mailing address
3025 BRECKINRIDGE BLVD, DULUTH, GA 30096-4979
(770) 270-1622
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
033519
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00531297A
—
GA
Enumeration date
06/13/2006
Last updated
07/08/2007
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