Healthcare Provider Details

I. General information

NPI: 1538273024
Provider Name (Legal Business Name): ALBERT B. MERCER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 CLEAR CREEK PKWY STE 2004
LAVONIA GA
30553-4271
US

IV. Provider business mailing address

PO BOX 742936
ATLANTA GA
30374-2936
US

V. Phone/Fax

Practice location:
  • Phone: 706-356-0554
  • Fax: 706-356-0557
Mailing address:
  • Phone: 770-219-8420
  • Fax: 770-219-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number079054
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: