Healthcare Provider Details

I. General information

NPI: 1558368845
Provider Name (Legal Business Name): MARIA G. AXELROD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 DANNON VW SW STE 2102
ATLANTA GA
30331-2156
US

IV. Provider business mailing address

910 DANNON VW SW STE 2102
ATLANTA GA
30331-2156
US

V. Phone/Fax

Practice location:
  • Phone: 404-691-6100
  • Fax: 404-691-6959
Mailing address:
  • Phone: 404-691-6100
  • Fax: 404-691-6959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number059367
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number229898
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: