Individual
ADA IVETTE MERCADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
687 MARIETTA HWY, CANTON, GA 30114-2608
(770) 704-1955
(770) 720-2388
Mailing address
55 WHITCHER ST NE, SUITE 350, MARIETTA, GA 30060-1155
(770) 424-6893
(770) 528-9938
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
51357
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000967029G
—
GA
05
—
000967029I
—
GA
05
—
000967029K
—
GA
05
—
000967029L
—
GA
05
—
000967029M
—
GA
Enumeration date
07/14/2006
Last updated
01/19/2015
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