Provider Demographics
NPI:1013014828
Name:PATRICK, MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:PATRICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4294 MEMORIAL DR
Mailing Address - Street 2:STE D
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1226
Mailing Address - Country:US
Mailing Address - Phone:404-296-4888
Mailing Address - Fax:404-296-8811
Practice Address - Street 1:4294 MEMORIAL DR
Practice Address - Street 2:STE D
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1226
Practice Address - Country:US
Practice Address - Phone:404-296-4888
Practice Address - Fax:404-296-8811
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor