Healthcare Provider Details

I. General information

NPI: 1184696973
Provider Name (Legal Business Name): MARK ALAN KOZINN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N PARK PL STE 200
STOCKBRIDGE GA
30281-7209
US

IV. Provider business mailing address

3537 KNOLLWOOD DR NW
ATLANTA GA
30305-1021
US

V. Phone/Fax

Practice location:
  • Phone: 678-289-7960
  • Fax:
Mailing address:
  • Phone: 404-231-1187
  • Fax: 404-364-9374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number16005
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number016005
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: