Provider Demographics
NPI:1376651653
Name:ACKERMAN, MARK D (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 888213
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30356-0213
Mailing Address - Country:US
Mailing Address - Phone:404-428-1887
Mailing Address - Fax:
Practice Address - Street 1:3280 HOWELL MILL RD NW
Practice Address - Street 2:217 E
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4111
Practice Address - Country:US
Practice Address - Phone:404-428-1887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1647103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical