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General NPI Number Information
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NPI Number | 1164817680
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Entity Type | Individual
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Provider Name | CHARLES MARCUS MD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 550 PEACHTREE ST NE DEPT OF
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City | ATLANTA
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State | GA
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Zip | 30308-2247
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Country | US
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Telephone | 404-712-4843
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Fax | 404-712-7435
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Provider Business Mailing Address
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Address Line | 170 AMSTERDAM AVE APT 20B
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City | NEW YORK
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State | NY
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Zip | 10023-5076
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Country | US
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Telephone | 443-831-7942
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 84780
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | 84780
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207UN0902X
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Taxonomy Name | Nuclear Imaging & Therapy Physician
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License Number | 84780
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 84780
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License Number State | GA
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