Provider Demographics
NPI:1518083617
Name:MARSHALL, PATRICE Y (MD)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:Y
Last Name:MARSHALL
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 1:2784 N DECATUR RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5903
Mailing Address - Country:US
Mailing Address - Phone:404-719-5999
Mailing Address - Fax:404-719-5998
Practice Address - Street 1:2784 N DECATUR RD STE 100
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5903
Practice Address - Country:US
Practice Address - Phone:404-719-5999
Practice Address - Fax:404-719-5998
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048274207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty