Provider Demographics
NPI:1376632794
Name:HINRICHS, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:HINRICHS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:8770 OLD SOUTHWICK PASS
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7160
Mailing Address - Country:US
Mailing Address - Phone:719-649-0979
Mailing Address - Fax:719-685-1422
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:404-616-7465
Practice Address - Fax:404-616-7465
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO34500208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01345008Medicaid
COF87786Medicare UPIN
COC41961Medicare PIN
COF87786Medicare UPIN