Organization Name: | MARIETTA HEALTHCARE LLC |
NPI Number: | 1447440524 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANA Y PAINE (OFFICE MANAGER) |
Mailing Address: | 2551 Roswell Rd Suite 415 Marietta |
State: | GA US |
Postal Code: | 300624762 |
Phone Number: | 7705652882 |
Fax Number: | 7704390297 |
NPI Enumeration Date: | 07/26/2007 |
NPI Last Update Date: | 07/26/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |