Individual
MARVAN HOWARD PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
495 WINN WAY, DECATUR, GA 30030-1736
(404) 389-0077
Mailing address
6578 CHESTNUT OAKS RDG, LITHONIA, GA 30038-4571
(770) 323-1567
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT009830
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116873
MEDICARE ID
GA
Enumeration date
01/12/2010
Last updated
01/12/2010
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