Mack, Dominic

Mack, Dominic is an sole proprietor health care provider with primary practice located at 1513 East Cleveland Ave Building 500, East Point GA 30344. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Mack, Dominic can be contacted via phone (404) 752-1000.

Contact Information

Primary practice address
1513 East Cleveland Ave Building 500 East Point GA 30344
Fax: (404) 752-1191
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 031630 Georgia

Profile Details

NPI number 1508866948
LBN Legal business name Mack, Dominic
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 28th, 2005
Last updated May 13th, 2019 - about 6 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 1508866948 NPPES
Georgia MEDICAID 000433892

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