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General NPI Number Information
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NPI Number | 1932167269
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Entity Type | Organization
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Legal Business Name | VASCULAR INSTITUTE OF GEORGIA, PC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5669 PEACHTREE DUNWOODY RD NE SUITE 100
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City | ATLANTA
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State | GA
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Zip | 30342-1786
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Country | US
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Telephone | 404-256-0404
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Fax | 404-847-0423
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Provider Business Mailing Address
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Address Line | 5669 PEACHTREE DUNWOODY RD NE SUITE 100
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City | ATLANTA
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State | GA
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Zip | 30342-1786
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Country | US
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Telephone | 404-256-0404
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Fax | 404-847-0423
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. MARK J MITTENTHAL
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Credential | M.D.
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Telephone | 404-256-0404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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