Provider Demographics
NPI:1427044858
Name:UNTERMAN, MARC I (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:I
Last Name:UNTERMAN
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 1:766 WALTHER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8764
Mailing Address - Country:US
Mailing Address - Phone:678-312-9100
Mailing Address - Fax:678-312-9101
Practice Address - Street 1:766 WALTHER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8764
Practice Address - Country:US
Practice Address - Phone:678-312-9100
Practice Address - Fax:678-312-9101
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19800207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00170607DMedicaid
GA00170607DMedicaid