Individual provider Active NPI

Mitchel Guttenplan, M.D.

  • Surgery Physician
  • Atlanta, GA
National Provider Identifier
1306958509
Registry record updated Apr 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
25166 Issued in GA
Practice address
755 Mount Vernon Hwy NE
Suite 350
Atlanta, GA 30328-4274
Phone
(404) 943-9579
Fax
(404) 943-9970
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 25166 GA Primary

Addresses

Primary practice location

755 Mount Vernon Hwy NE
Suite 350
Atlanta, GA 30328-4274

Mailing address

4040 Lake Washington Blvd NE
Suite 100
Kirkland, WA 98033-7874
Phone (425) 284-7890

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, IL, TN, TX, CO, VA, CA7 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
I20070111000195 GA Practitioner - General Surgery 6002816311
I20220625000307 IL Practitioner - General Surgery 6002816311
I20220721000378 TN Practitioner - General Surgery 6002816311
I20220727002427 TX Practitioner - General Surgery 6002816311
I20220727002739 CO Practitioner - General Surgery 6002816311
I20220909001034 VA Practitioner - General Surgery 6002816311
I20221020000436 CA Practitioner - General Surgery 6002816311

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25166GAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Colorado CRH Surgeons, P.C. CurrentSince Feb 15, 2008 Accepting new patients
Texas CRH Surgeons PA CurrentSince Feb 15, 2008 Accepting new patients
CRH Clinic of Atlanta Surgery Past Accepting new patients
Greater Charlotte Support Services, PLLC PastSince Dec 12, 2025 Accepting new patients

Locations

4040 Lk Wa Blvd NE
Ste 100
Kirkland, WA 98033

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240531200000",
    "number": "1306958509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4040 LAKE WASHINGTON BLVD NE",
            "address_2": "SUITE 100",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980337874",
            "telephone_number": "425-284-7890",
            "fax_number": "425-284-7896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 MOUNT VERNON HWY NE",
            "address_2": "SUITE 350",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303284274",
            "telephone_number": "404-943-9579",
            "fax_number": "404-943-9970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTTENPLAN",
        "first_name": "MITCHEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2009-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "25166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.