Healthcare Provider Details

I. General information

NPI: 1932583705
Provider Name (Legal Business Name): MARLON DAVID ANTHONY FOOTE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2015
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 PEACHTREE BLVD STE 510
CHAMBLEE GA
30341-2811
US

IV. Provider business mailing address

5001 PEACHTREE BLVD STE 510
CHAMBLEE GA
30341-2811
US

V. Phone/Fax

Practice location:
  • Phone: 404-902-5820
  • Fax:
Mailing address:
  • Phone: 404-902-5820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN123661
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN21076
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: