Healthcare Provider Details

I. General information

NPI: 1639117401
Provider Name (Legal Business Name): MARK WILLIAM MCCORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 11/25/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 PRESTON RIDGE RD STE 100
ALPHARETTA GA
30005-4509
US

IV. Provider business mailing address

#1107 3344 COBB PARKWAY STE 200
ACWORTH GA
30102
US

V. Phone/Fax

Practice location:
  • Phone: 770-350-0126
  • Fax: 770-350-6637
Mailing address:
  • Phone: 770-350-0126
  • Fax: 770-515-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number043704
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: