Provider Demographics
NPI:1760563845
Name:MEMARK, JANET PAK (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:PAK
Last Name:MEMARK
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 1:1650 COUNTY SERVICES PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-4010
Mailing Address - Country:US
Mailing Address - Phone:770-739-3214
Mailing Address - Fax:770-514-2811
Practice Address - Street 1:1650 COUNTY SERVICES PARKWAY
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-4010
Practice Address - Country:US
Practice Address - Phone:770-739-3214
Practice Address - Fax:770-514-2811
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115379207R00000X
GA64415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003204089AMedicaid