Provider Demographics
NPI:1396144143
Name:RADKE, MARILYN SZYMIALIS (MD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:SZYMIALIS
Last Name:RADKE
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 1:2330 N PEACHTREE CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5960
Mailing Address - Country:US
Mailing Address - Phone:770-986-8796
Mailing Address - Fax:
Practice Address - Street 1:2330 N PEACHTREE CT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5960
Practice Address - Country:US
Practice Address - Phone:770-986-8796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA510802083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine