Healthcare Provider Details

I. General information

NPI: 1558587188
Provider Name (Legal Business Name): MARK AARON LEWINTER DACM, L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6255 BARFIELD RD NE STE 175
ATLANTA GA
30328-4319
US

IV. Provider business mailing address

6255 BARFIELD RD NE STE 175
ATLANTA GA
30328-4319
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-8388
  • Fax: 404-255-1831
Mailing address:
  • Phone: 404-255-8388
  • Fax: 404-255-1831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number39
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: