Individual
MITRA POORAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
160 ACADEMY AVE, GREENWOOD, SC 29646-3808
(864) 725-4111
Mailing address
1444 VALLEY VIEW RD, ATLANTA, GA 30338-4825
(404) 516-1024
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
008421
GA
208600000X
Surgery Physician
036-161760
IL
208600000X
Surgery Physician
Primary
88999
SC
Other
Enumeration date
05/09/2015
Last updated
08/05/2025
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