Healthcare Provider Details

I. General information

NPI: 1508904715
Provider Name (Legal Business Name): MARC J KORNFIELD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 11/20/2007
Certification Date:
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 Number
License Number State

VIII. Authorized Official

Name: MR. WALTER E DENIS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 770-425-1170