Provider Demographics
NPI:1982620811
Name:MERCADO, ADA IVETTE (MD)
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:IVETTE
Last Name:MERCADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-424-6893
Mailing Address - Fax:770-528-9938
Practice Address - Street 1:687 MARIETTA HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2608
Practice Address - Country:US
Practice Address - Phone:770-704-1955
Practice Address - Fax:770-720-2388
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA51357207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000967029KMedicaid
GA000967029MMedicaid
GA000967029IMedicaid
GA000967029LMedicaid
GA000967029GMedicaid
GA000967029KMedicaid
GA000967029GMedicaid