MARK L WETHERLY (NPI# 1578515128) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578515128 |
| Entity Type | Individual |
| Full Name | MARK L WETHERLY |
| Credential | MD |
| Practice Address |
790 Church St Ne Ste 400 Marietta GA 30060-7282 |
| Mailing Address |
Po Box 3157 Indianapolis IN 46206-3157 |
| Practice Telephone | 7709528899 |
| Mailing Telephone | 7709528899 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2016-05-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
050851 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000940332 | 05 |
| Street Address |
790 CHURCH ST NE STE 400 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-7282 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720083702 | Roberto A. Larrivey | Otolaryngology | 790 Church St Ne, Ste 140, Marietta, GA 30060-8902 | 2005-06-16 |
| 1003356361 | Proactive Physicians of Marietta, PC | Clinic/Center | 790 Church St Ne, Suite 220, Marietta, GA 30060-7282 | 2017-03-06 |
| 1720535529 | Tracy Zoblisein | Pharmacist | 790 Church St Ne, Suite 335, Marietta, GA 30060-7282 | 2016-09-09 |
| 1609323641 | Lisa Long | Pharmacist | 790 Church St Ne, Suite 335, Marietta, GA 30060-7282 | 2016-09-07 |
| 1306293113 | Kristina L Thomas | Nurse Practitioner | 790 Church St Ne, Suite 150, Marietta, GA 30060-7282 | 2016-05-21 |
| 1447681218 | James Wesley Garrett | Physician Assistant | 790 Church St Ne, Ste 400, Marietta, GA 30060-7282 | 2013-12-04 |
| 1396083606 | Deborah Luann Hurd | Nurse Practitioner | 790 Church St Ne, Suite 330, Marietta, GA 30060-7282 | 2013-01-21 |
| 1336485457 | Paradigm Medical LLC | Specialist | 790 Church St Ne, Suite 410, Marietta, GA 30060-7282 | 2012-12-18 |
| 1679824742 | Nsh Cancer Institute Professional Services G LLC | Durable Medical Equipment & Medical Supplies | 790 Church St Ne, Suite 335, Marietta, GA 30060-7282 | 2012-09-28 |
| 1568724052 | Brandon M Paritz | Family Medicine | 790 Church St Ne, Suite 250, Marietta, GA 30060-7282 | 2012-06-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144845116 | Legacy Center for Spinal Surgery, LLC | Neurological Surgery | 1900 The Exchange, Ne, Suite 600, Marietta, GA 30060 | 2020-06-15 |
| 1407477193 | Michael Cynil Daniel | Counselor | 698 N Marietta, Pkwy, Marietta, GA 30060 | 2020-05-04 |
| 1285253401 | Cameron Thomas Kennelly | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne Attn:gme, Marietta, GA 30060 | 2020-04-09 |
| 1922640739 | Jeremiah George Blair | Physician Assistant | 61 Whitcher St Suite 2100, Marietta, GA 30060 | 2019-10-14 |
| 1164064945 | Denise Alicia Mick | Registered Nurse | 677 Church St Wellstar Kennestone Hospital, Marietta, GA 30060 | 2019-10-12 |
| 1184283772 | Iora Health Georgia, P.C. | Internal Medicine | 280 Cobb Pkwy Se, Suite 60, Marietta, GA 30060 | 2019-06-07 |
| 1346703212 | Caitlin Virginia Mueller | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne, Attn: Gme, Marietta, GA 30060 | 2019-04-08 |
| 1184187205 | Adero Francis | Student in an Organized Health Care Education/Training Program | Wellstar Kennestone Gme Internal Medicine Clinic, 833 Campbell Hill St Nw, Suite 250, Marietta, GA 30060 | 2019-04-08 |
| 1659832749 | Matthew Mozzo | Student in an Organized Health Care Education/Training Program | 677 Church Street / Lower Level, Gme Department / I.m., Marietta, GA 30060 | 2019-03-29 |
| 1245797430 | La'myia Spentz | Specialist | 109 Anderson St Ne, Suite 608, Marietta, GA 30060 | 2019-02-25 |
| Find all providers in zip 30060 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740454412 | Sandra Parada-orrego | Radiology | 2963 Nestle Creek Dr, Marietta, GA 30062-4802 | 2008-04-14 |
| 1073705893 | Joel Edward Berenson | Radiology | 702 Canton Road, Marietta, GA 30060 | 2007-08-15 |
| 1013053073 | Thomas Patrick Murphy | Radiology | 598 Nancy Street Suite 150, Marietta, GA 30114-6312 | 2007-01-29 |
| 1578644258 | John Theodore Perry IIi | Radiology | 711 Canton Rd Ne Ste 220, Marietta, GA 30060-8949 | 2006-10-18 |
| 1134156086 | Diane Clary Jensen | Radiology | 4630 Gateside Ln Se, Marietta, GA 30067-4087 | 2006-06-27 |
| 1881654648 | Kenneth P Lynch IIi | Radiology | 598 Nancy St Nw, Suite 100, Marietta, GA 30060-1362 | 2006-03-24 |
| 1871578971 | Eric Scott Brecher | Radiology | 241 W Market St, Marietta, PA 17547-1413 | 2005-12-12 |
| 1932615648 | T2 Imaging | Radiology | 1070 Woodlawn Dr Ne, Marietta, GA 30068 | 2017-12-18 |
| 1164777934 | Mohit K Gupta | Radiology | 790 Church St Ne Ste 400, Marietta, GA 30060 | 2012-07-18 |
| 1841550886 | Dale Kyung Han | Radiology | 790 Church St Ne Ste 400, Marietta, GA 30060 | 2012-05-24 |
| Find all providers in MARIETTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.