| Organization Name: | MARIETTA RECOVERY CENTERS, INC |
| NPI Number: | 1538518931 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WENDY JENNINGS (OWNER) |
| Mailing Address: | 70 Gruber Ln Suite 107 St Simons Island |
| State: | GA US |
| Postal Code: | 315222881 |
| Phone Number: | 4042375519 |
| Fax Number: | 4042622557 |
| NPI Enumeration Date: | 06/07/2016 |
| NPI Last Update Date: | 06/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |