Provider Demographics
NPI:1164749883
Name:MARK A CODNER MD LLC
Entity Type:Organization
Organization Name:MARK A CODNER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CODNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-351-4151
Mailing Address - Street 1:1800 HOWELL MILL RD NW STE 140
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2538
Mailing Address - Country:US
Mailing Address - Phone:404-351-4151
Mailing Address - Fax:404-351-4152
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 140
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2538
Practice Address - Country:US
Practice Address - Phone:404-351-4151
Practice Address - Fax:404-351-4152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
035592208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
035592OtherSTATE LICENSE
F82426Medicare UPIN