MEDICARE: DR. MARK J. GREENBAUM D.P.M.

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	213E00000X	Podiatrist	POD000611	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	480020017	OTHER	GA	RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1750335428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK J. GREENBAUM D.P.M.

Provider Business Mailing Address
First Line	:	1835 SAVOY DR STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-1073
Country	:	US
Telephone Number	:	770-279-2900
Fax Number	:	770-279-0351

Provider Business Practice Location Address
First Line	:	1835 SAVOY DR STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-1073
Country	:	US
Telephone Number	:	770-279-2900
Fax Number	:	770-279-0351

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	01/31/2020

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Directions to “ DR. MARK J. GREENBAUM D.P.M.” Practice Location

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