Provider Demographics
NPI:1568701498
Name:MARSHALL, JOHN BENJAMIN
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BENJAMIN
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 PEACHTREE DUNWOODY RD STE 325
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6773
Mailing Address - Country:US
Mailing Address - Phone:404-876-1906
Mailing Address - Fax:
Practice Address - Street 1:6135 BARFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-256-8500
Practice Address - Fax:404-256-8506
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79823207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program