Mark Icenogle, AT-C

NPI 1306800610 · on the registry since 2006

Practice

Address: 758 Old Norcross Rd
Lawrenceville, GA 30045
Phone: (678) 985-7190
Fax: (678) 985-7158
Organisation at this address: Resurgens, Llc
Lawrenceville Surgery Center, Llc
North Atlanta Endocrinology And Diabetes, Pc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 45

Registry record

Primary taxonomy: 2255A2300X
2255A2300X
Licence states on file: GA
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2008-04-08

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Georgia