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NPI Code Detail

MEDICARE: MARK VAKKUR, M.D., P.C.

MEDICARE: MARK VAKKUR, M.D., P.C.
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
12084P0800XPsychiatry Physician47548GA

General Provider Information

NPI Number : 1790831972
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARK VAKKUR, M.D., P.C.
Provider Business Mailing Address
First Line : 1751 VICKERS CIR
Second Line :
City : DECATUR
State : GA
Zip : 30030-1033
Country : US
Telephone Number : 404-486-7450
Fax Number :
Provider Business Practice Location Address
First Line : 2200 CENTURY PKWY NE
Second Line : SUITE 200
City : ATLANTA
State : GA
Zip : 30345-3154
Country : US
Telephone Number : 404-486-7450
Fax Number :
Authorized Official
Title or Position : PRINCIPAL
Name : MARK VAKKUR
Credential : M.D.
Telephone Number : 404-486-7450
Provider Enumeration Date : 01/28/2007
Last Update Date : 03/24/2008

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