MEDICARE: DR. MARCUS Q. POLK M.D.

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	208VP0014X	Interventional Pain Medicine Physician	040758	GA
2	207L00000X	Anesthesiology Physician	040758	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050067085	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669454575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCUS Q. POLK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 370160
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30037-0160
Country	:	US
Telephone Number	:	404-403-4567
Fax Number	:	404-920-8185

Provider Business Practice Location Address
First Line	:	76 HIGHLAND PAVILION CT STE 133
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-3170
Country	:	US
Telephone Number	:	800-533-8210
Fax Number	:	404-745-8013

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	08/09/2024

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Directions to “ DR. MARCUS Q. POLK M.D.” Practice Location

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