Healthcare Provider Details

I. General information

NPI: 1821092669
Provider Name (Legal Business Name): MARC MERRICK DEAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 TURNER MCCALL BLVD SW
ROME GA
30165-5630
US

IV. Provider business mailing address

221 TECHNOLOGY PKWY NW
ROME GA
30165-1369
US

V. Phone/Fax

Practice location:
  • Phone: 706-291-1754
  • Fax: 706-291-2227
Mailing address:
  • Phone: 762-235-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number057359
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: