MEDICARE: CHRISTINA MARCELUS 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	207N00000X	Dermatology Physician	104649	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104649	OTHER	GA	GEORGIA

General Provider Information

NPI Number	:	1669052932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARCELUS MD

Provider Business Mailing Address
First Line	:	3225 CUMBERLAND BLVD SE STE 510
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-6396
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 CUMBERLAND BLVD SE STE 510
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-6396
Country	:	US
Telephone Number	:	404-806-6330
Fax Number	:

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

Provider Enumeration Date	:	04/12/2021
Last Update Date	:	04/13/2026

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