MEDICARE: MARIOLY PENA-DONADY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN187347	GA

General Provider Information

NPI Number	:	1972048353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIOLY PENA-DONADY

Provider Business Mailing Address
First Line	:	2727 PACES FERRY RD SE STE 1-100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-6150
Country	:	US
Telephone Number	:	470-271-3418
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 COLLIER RD NW STE 5015
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309
Country	:	US
Telephone Number	:	404-605-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2016
Last Update Date	:	08/06/2019

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Directions to “ MARIOLY PENA-DONADY ” Practice Location

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