Provider Demographics
NPI:1538273024
Name:MERCER, ALBERT B (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:B
Last Name:MERCER
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:PO BOX 742936
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2936
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:770-219-8440
Practice Address - Street 1:355 CLEAR CREEK PKWY STE 2004
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-4271
Practice Address - Country:US
Practice Address - Phone:706-356-0554
Practice Address - Fax:706-356-0557
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA079054207RC0000X, 207RC0000X
IN01034208A207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64230683Medicaid
GA003200990AMedicaid
IN200010250AMedicaid
KYC68300Medicare UPIN
IN631130CMedicare PIN
IN631130CMedicare PIN
KY64230683Medicaid
KY0320402Medicare PIN
KY0409402Medicare PIN
KYC68300Medicare UPIN
060030344Medicare PIN