Healthcare Provider Details

I. General information

NPI: 1053452979
Provider Name (Legal Business Name): ALSON MERCURIUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 CHURCH ST NE
MARIETTA GA
30060-1101
US

IV. Provider business mailing address

531 ROSELANE ST NW STE 830
MARIETTA GA
30060-6979
US

V. Phone/Fax

Practice location:
  • Phone: 770-794-0477
  • Fax: 770-794-3108
Mailing address:
  • Phone: 770-794-0477
  • Fax: 770-794-3108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number061125
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number061125
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number061125
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number061125
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number61125
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: