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NPI Code Detail

MEDICARE: MARIE MCKINNON

MEDICARE: MARIE MCKINNON
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
1207R00000XInternal Medicine Physician036146809IL
2207R00000XInternal Medicine Physician85696GA

General Provider Information

NPI Number : 1477948040
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE MCKINNON
Provider Business Mailing Address
First Line : 1030 DELTA BLVD
Second Line :
City : ATLANTA
State : GA
Zip : 30354-1989
Country : US
Telephone Number : 404-778-8281
Fax Number :
Provider Business Practice Location Address
First Line : 1030 DELTA BLVD
Second Line :
City : ATLANTA
State : GA
Zip : 30354-1989
Country : US
Telephone Number : 404-778-8281
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2015
Last Update Date : 07/15/2020

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Directions to “ MARIE MCKINNON ” Practice Location

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