Healthcare Provider Details

I. General information

NPI: 1841215647
Provider Name (Legal Business Name): MARK VRANICAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 HARPER ST FL 6
AUGUSTA GA
30912-0001
US

IV. Provider business mailing address

1120 15TH ST # BA8305
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-8522
  • Fax:
Mailing address:
  • Phone: 706-721-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number36423
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number89693
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: