Healthcare Provider Details

I. General information

NPI: 1588631923
Provider Name (Legal Business Name): ROBERT MARTIN MARCUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4890 ROSWELL RD SUITE 250
ATLANTA GA
30342-2606
US

IV. Provider business mailing address

4890 ROSWELL RD SUITE 250
ATLANTA GA
30342-2606
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-9244
  • Fax: 404-255-9114
Mailing address:
  • Phone: 404-255-9244
  • Fax: 404-255-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number035469
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: