Organization
VASCULAR INSTITUTE OF GEORGIA, PC
Active
Other names
Vascular Insitute of Georiga, PC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK J MITTENTHAL M.D. (PHYSICIAN)
(404) 256-0404
Entity
Organization
Contact information
Practice address
5669 PEACHTREE DUNWOODY RD NE, SUITE 100, ATLANTA, GA 30342-1786
(404) 256-0404
(404) 847-0423
Mailing address
5669 PEACHTREE DUNWOODY RD NE, SUITE 100, ATLANTA, GA 30342-1786
(404) 256-0404
(404) 847-0423
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00206005I
—
GA
05
—
00216466H
—
GA
05
—
00460039E
—
GA
01
—
1033184767
J. MARK RHEUDASIL
GA
01
—
1376517300
ALAN KOORNICK
GA
01
—
1528028925
MICHAEL D. CLARK
GA
01
—
1598739559
MARK MITTENTHAL
GA
01
—
1629038476
PETER H'DOUBLER JR.
GA
01
—
1861466955
MARK G. COAN
GA
Enumeration date
05/03/2006
Last updated
08/22/2020
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