MEDICARE: DR. TRACEY IRVIN MARKS 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	2084F0202X	Forensic Psychiatry Physician	50185	GA
2	2084P0800X	Psychiatry Physician	50185	GA

General Provider Information

NPI Number	:	1942281324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACEY IRVIN MARKS MD

Provider Business Mailing Address
First Line	:	3975 ROSWELL RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-4119
Country	:	US
Telephone Number	:	404-327-5194
Fax Number	:	404-719-5067

Provider Business Practice Location Address
First Line	:	3975 ROSWELL RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-4119
Country	:	US
Telephone Number	:	404-327-5194
Fax Number	:	404-719-5067

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	06/26/2013

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