MEDICARE: MARIAH BURCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	92717	GA

General Provider Information

NPI Number	:	1083270466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH BURCH MD

Provider Business Mailing Address
First Line	:	1405 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1060
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1900
Country	:	US
Telephone Number	:	404-785-5437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2019
Last Update Date	:	04/25/2024

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Directions to “ MARIAH BURCH MD” Practice Location

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