Provider Demographics
NPI:1922244011
Name:SCHWARTZ, MARK IAN (L AC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:IAN
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 FITZPATRICK WAY
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1037
Mailing Address - Country:US
Mailing Address - Phone:678-549-7848
Mailing Address - Fax:
Practice Address - Street 1:107 W PACES FERRY RD NW
Practice Address - Street 2:TERRACE LEVEL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1398
Practice Address - Country:US
Practice Address - Phone:678-549-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000187171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist