Healthcare Provider Details

I. General information

NPI: 1720428063
Provider Name (Legal Business Name): MARK A BENAK MD ATLANTA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 PEACHTREE RD NE SUITE 425
ATLANTA GA
30326-1157
US

IV. Provider business mailing address

4350 TOWNE CENTRE DR SUITE 2000
EVANS GA
30809-3301
US

V. Phone/Fax

Practice location:
  • Phone: 404-846-2440
  • Fax: 404-846-2460
Mailing address:
  • Phone: 706-854-3333
  • Fax: 706-854-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KELLY VANN
Title or Position: CEO
Credential:
Phone: 706-854-2138