Provider Demographics
NPI:1639117401
Name:MCCORD, MARK WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILLIAM
Last Name:MCCORD
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:#1107
Mailing Address - Street 2:3344 COBB PARKWAY STE 200
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102
Mailing Address - Country:US
Mailing Address - Phone:770-350-0126
Mailing Address - Fax:770-515-9502
Practice Address - Street 1:3330 PRESTON RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4509
Practice Address - Country:US
Practice Address - Phone:770-350-0126
Practice Address - Fax:770-350-6637
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0437042085R0001X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000895771HMedicaid
GA000895771NMedicaid
GA000895771LMedicaid
GA000895771MMedicaid
GA92BBGBVOtherMEDICARE PROVIDER ID
GA000895771IMedicaid
GA000895771KMedicaid
GA000895771JMedicaid
GA000895771LMedicaid