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121 Marble Mill Rd Nw Suite 202 Marietta GA 30060-7959 | |
| (770) 218-9135 | |
| (866) 224-2735 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 121 Marble Mill Rd Nw, Marietta, Georgia |
| Authorized Official Name and Position | Mark A Chishom (ORAL SURGEON) |
| Authorized Official Contact | 7702189135 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
121 Marble Mill Rd Nw Suite 202 Marietta GA 30060-7959 Ph: (770) 218-9135 | 121 Marble Mill Rd Nw Suite 202 Marietta GA 30060-7959 Ph: (770) 218-9135 |
| NPI Number | 1104172741 |
|---|---|
| Provider Enumeration Date | 08/01/2012 |
| Last Update Date | 08/01/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104172741 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DN014013 (Georgia) | Primary |
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