Provider Demographics
NPI:1578677324
Name:MURPHY, MARK WATKINS (MDIV)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WATKINS
Last Name:MURPHY
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HIGHLAND LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3441
Mailing Address - Country:US
Mailing Address - Phone:404-321-6111
Mailing Address - Fax:404-329-2235
Practice Address - Street 1:113 HIGHLAND LAKE CIR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3441
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-329-2235
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral