Provider Demographics
NPI:1881613917
Name:PLOTKIN, MARAT V (MD)
Entity type:Individual
Prefix:
First Name:MARAT
Middle Name:V
Last Name:PLOTKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GREENCASTLE RD
Mailing Address - Street 2:STE A
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290
Mailing Address - Country:US
Mailing Address - Phone:770-631-1040
Mailing Address - Fax:770-631-1019
Practice Address - Street 1:105 GREENCASTLE RD
Practice Address - Street 2:STE A
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290
Practice Address - Country:US
Practice Address - Phone:770-631-1040
Practice Address - Fax:770-631-1019
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046473208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000804724XMedicaid
37BBFGKMedicare ID - Type Unspecified
GA000804724XMedicaid