Provider Demographics
NPI:1639533581
Name:MARK, APARNA (MD)
Entity Type:Individual
Prefix:
First Name:APARNA
Middle Name:
Last Name:MARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 N SHALLOWFORD RD STE B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6476
Mailing Address - Country:US
Mailing Address - Phone:404-778-6920
Mailing Address - Fax:404-778-6901
Practice Address - Street 1:4500 N SHALLOWFORD RD
Practice Address - Street 2:SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6476
Practice Address - Country:US
Practice Address - Phone:404-778-6920
Practice Address - Fax:404-778-6901
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA82044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program