Healthcare Provider Details

I. General information

NPI: 1336201508
Provider Name (Legal Business Name): SARA MARDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 JOHNSON FERRY RD NE SUITE 620
ATLANTA GA
30342-1626
US

IV. Provider business mailing address

980 JOHNSON FERRY RD NE SUITE 620
ATLANTA GA
30342-1626
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-2057
  • Fax: 404-256-4238
Mailing address:
  • Phone: 404-255-2057
  • Fax: 404-256-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number036814
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: