MEDICARE: SALLY J MARCUS

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	028601	GA

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

General Provider Information

NPI Number	:	1780684894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY J MARCUS

Provider Business Mailing Address
First Line	:	333 SANDY SPRINGS CIR NE
Second Line	:	STE 207
City	:	ATLANTA
State	:	GA
Zip	:	30328-3897
Country	:	US
Telephone Number	:	404-705-8990
Fax Number	:	404-705-9984

Provider Business Practice Location Address
First Line	:	1140 HAMMOND DR NE
Second Line	:	STE E 5250
City	:	ATLANTA
State	:	GA
Zip	:	30328-5338
Country	:	US
Telephone Number	:	404-256-2688
Fax Number	:	404-256-1820

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/08/2007

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Directions to “ SALLY J MARCUS ” Practice Location

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