Healthcare Provider Details

I. General information

NPI: 1184676413
Provider Name (Legal Business Name): JOHN JEFFREY MARSHALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W PEACHTREE ST NW STE 920
ATLANTA GA
30309-3609
US

IV. Provider business mailing address

1110 W PEACHTREE ST NW STE 920
ATLANTA GA
30309-3609
US

V. Phone/Fax

Practice location:
  • Phone: 404-962-6000
  • Fax: 404-962-6001
Mailing address:
  • Phone: 404-962-6000
  • Fax: 404-962-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number034895
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number034895
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: