Chastain, Mark Alan

Chastain, Mark Alan is an individual health care provider with primary practice located at 835 Cogburn Ave Nw Suite 100, Marietta GA 30060-1031. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery, Allopathic & Osteopathic Physicians / Dermatology. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Chastain, Mark Alan can be contacted via phone (770) 422-5557.

Contact Information

Primary practice address
835 Cogburn Ave Nw Suite 100 Marietta GA 30060-1031
Phone: (770) 422-5557
Fax: (770) 422-5456
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X 048995 Georgia
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 048995 Georgia

Profile Details

NPI number 1790756138
LBN Legal business name Chastain, Mark Alan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 1st, 2006
Last updated Jun 12th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790756138 NPPES
Georgia MEDICAID 339883816A
Georgia Other P00086676

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