Provider Demographics
NPI:1437155074
Name:THAMES, MARC D (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:D
Last Name:THAMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1956 WESTMINSTER WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1137
Mailing Address - Country:US
Mailing Address - Phone:602-625-4696
Mailing Address - Fax:404-616-4400
Practice Address - Street 1:49 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3049
Practice Address - Country:US
Practice Address - Phone:404-616-0440
Practice Address - Fax:404-616-4400
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA77954207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ14-14505OtherUNITED HEALTHCARE
AZ2Z0917OtherHEALTHNET
AZ850736Medicaid
AZP00139907OtherRAILROAD MEDICARE
AZAZ0752400OtherBLUE CROSS BLUE SHIELD
AZ14-14505OtherUNITED HEALTHCARE
AZ850736Medicaid