Provider Demographics
NPI: | 1720428063 |
---|---|
Name: | MARK A BENAK MD ATLANTA PC |
Entity Type: | Organization |
Organization Name: | MARK A BENAK MD ATLANTA PC |
Other - Org Name: | VEIN GUYS ATLANTA |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | KELLY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | VANN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 706-854-2138 |
Mailing Address - Street 1: | 4350 TOWNE CENTRE DR |
Mailing Address - Street 2: | SUITE 2000 |
Mailing Address - City: | EVANS |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30809-3301 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 706-854-3333 |
Mailing Address - Fax: | 706-854-2149 |
Practice Address - Street 1: | 3390 PEACHTREE RD NE |
Practice Address - Street 2: | SUITE 425 |
Practice Address - City: | ATLANTA |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30326-1157 |
Practice Address - Country: | US |
Practice Address - Phone: | 404-846-2440 |
Practice Address - Fax: | 404-846-2460 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-07-01 |
Last Update Date: | 2013-07-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |