Healthcare Provider Details

I. General information

NPI: 1013991371
Provider Name (Legal Business Name): MARK F DEUTSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 JOHNSON FERRY RD NE SUITE 760
ATLANTA GA
30342-1626
US

IV. Provider business mailing address

980 JOHNSON FERRY RD NE SUITE 760
ATLANTA GA
30342-1626
US

V. Phone/Fax

Practice location:
  • Phone: 770-461-4824
  • Fax: 770-461-2601
Mailing address:
  • Phone: 770-461-4824
  • Fax: 770-461-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number044444
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: