Provider Demographics
NPI:1427027101
Name:DUNN, MARISA (MD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 CANDLER RD STE 500
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-5572
Mailing Address - Country:US
Mailing Address - Phone:404-836-0272
Mailing Address - Fax:404-284-9027
Practice Address - Street 1:2124 CANDLER RD STE 500
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-5572
Practice Address - Country:US
Practice Address - Phone:404-836-0272
Practice Address - Fax:404-284-9027
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134U6Medicaid
NCH86434Medicare UPIN
NC2017639BMedicare ID - Type Unspecified