Provider Demographics
NPI:1144424797
Name:DARTER, MERVIN LEROY (MSW)
Entity Type:Individual
Prefix:MR
First Name:MERVIN
Middle Name:LEROY
Last Name:DARTER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 N PELHAM RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5260
Mailing Address - Country:US
Mailing Address - Phone:404-541-3008
Mailing Address - Fax:
Practice Address - Street 1:2300 LAKE PARK DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4076
Practice Address - Country:US
Practice Address - Phone:404-872-5027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0026021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical