Individual provider Active NPI

Janet Pak Memark, M.D.

  • Internal Medicine Physician
  • Marietta, GA
National Provider Identifier
1760563845
Registry record updated Mar 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
64415 Issued in GA
Practice address
1650 County Services Parkway
Marietta, GA 30008-4010
Phone
(770) 739-3214
Fax
(770) 514-2811
NPI assigned
Oct 17, 2006
Last updated
Mar 28, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036115379 IL
Internal Medicine Physician 207R00000X 64415 GA Primary

Addresses

Primary practice location

1650 County Services Parkway
Marietta, GA 30008-4010

Mailing address

1650 County Services Parkway
Marietta, GA 30008-4010
Phone (770) 739-3214

Other identifiers 1

IdentifierTypeStateIssuer
003204089AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101218000078 GA Practitioner - Internal Medicine 9436347317 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Miami, LM Miller School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1650 County Service Pkwy SW
Marietta, GA 30008-4010
Phone (770) 514-2300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
64415GAMDInternal Medicine Physician
036115379ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Douglas County Board of Health CurrentSince Mar 12, 2018 Accepting new patients
Cobb County Board of Health PastSince Aug 2, 2020 Accepting new patients

Locations

6770 Selman Dr
Douglasville, GA 30134
Phone (770) 514-2300

1650 County Services Pkwy SW
Marietta, GA 30008
Phone (770) 514-2300

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553731200000",
    "number": "1760563845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 COUNTY SERVICES PARKWAY",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300084010",
            "telephone_number": "770-739-3214",
            "fax_number": "770-514-2811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COUNTY SERVICES PARKWAY",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300084010",
            "telephone_number": "770-739-3214",
            "fax_number": "770-514-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEMARK",
        "first_name": "JANET",
        "middle_name": "PAK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2019-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036115379",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "64415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003204089A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.