Provider Demographics
NPI:1659372415
Name:POLLOCK, MARK T (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2665 N DECATUR RD STE 440
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6146
Mailing Address - Country:US
Mailing Address - Phone:404-501-7584
Mailing Address - Fax:404-501-7652
Practice Address - Street 1:2665 N DECATUR RD STE 440
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6146
Practice Address - Country:US
Practice Address - Phone:404-501-7533
Practice Address - Fax:404-501-7652
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA032275207RC0200X, 207RP1001X
GA32275207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00420175EMedicaid
GA00420175EMedicaid
GAE23455Medicare UPIN