Basic Information
| Provider Information | |||||||||
| NPI: | 1598928111 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARCUS AUTISM CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 TULLIE CIR NE | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303292303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047857000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1920 BRIARCLIFF RD NE | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303294010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044194000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2008 | ||||||||
| LastUpdateDate: | 10/10/2013 | ||||||||
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| AuthorizedOfficialLastName: | HYLAND | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4047857000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD1600X | Y | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
No ID Information.