Provider Demographics
NPI:1720584329
Name:MOREL, MARK F JR
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:MOREL
Suffix:JR
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 1:265 PONCE DE LEON AVE NE UNIT 3201
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1979
Mailing Address - Country:US
Mailing Address - Phone:404-791-8720
Mailing Address - Fax:
Practice Address - Street 1:895 CANTON RD NE BLDG 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8935
Practice Address - Country:US
Practice Address - Phone:770-427-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA91708207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program