Healthcare Provider Details

I. General information

NPI: 1679770887
Provider Name (Legal Business Name): FRANKLIN T VON HACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

696 WINDY HILL RD SE
SMYRNA GA
30080-1857
US

IV. Provider business mailing address

3369 BUFORD HWY NE SUITE 810
BROOKHAVEN GA
30329-3722
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-4692
  • Fax: 404-321-4366
Mailing address:
  • Phone: 404-321-4692
  • Fax: 404-321-4366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number039501
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: