MEDICARE: DR. VANCHAD C MEMARK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	64416	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013196492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANCHAD C MEMARK M.D.

Provider Business Mailing Address
First Line	:	148 BILL CARRUTH PKWY
Second Line	:	SUITE 180
City	:	HIRAM
State	:	GA
Zip	:	30141-3754
Country	:	US
Telephone Number	:	770-445-4915
Fax Number	:	770-445-2876

Provider Business Practice Location Address
First Line	:	148 BILL CARRUTH PKWY
Second Line	:	SUITE 180
City	:	HIRAM
State	:	GA
Zip	:	30141-3754
Country	:	US
Telephone Number	:	770-445-4915
Fax Number	:	770-445-2876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	01/30/2017

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