Healthcare Provider Details

I. General information

NPI: 1336201292
Provider Name (Legal Business Name): MARY JACQUELINE HOFFMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 PEACHTREE DUNWOODY RD NE
ATLANTA GA
30342-1701
US

IV. Provider business mailing address

5665 PEACHTREE DUNWOODY RD NE
ATLANTA GA
30342-1701
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-1968
  • Fax: 404-252-4609
Mailing address:
  • Phone: 404-252-1968
  • Fax: 404-252-4609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberGA38799
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: