Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 84780 | GA |
NPI | 1164817680 |
---|---|
Provider Name | Dr. Charles Marcus |
First Address | Atlanta, GA 30329-2268 |
Second Address | Atlanta, GA 30322-1059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2015 |
Last Update Date | 04/03/2021 |