Healthcare Provider Details

I. General information

NPI: 1053432401
Provider Name (Legal Business Name): MARC JOEL KORNFIELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 CANTON RD STE C
MARIETTA GA
30066-6053
US

IV. Provider business mailing address

1335 CANTON RD STE C
MARIETTA GA
30066-6053
US

V. Phone/Fax

Practice location:
  • Phone: 770-425-1170
  • Fax: 770-425-1137
Mailing address:
  • Phone: 770-425-1170
  • Fax: 770-425-1137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number028807
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: