Healthcare Provider Details

I. General information

NPI: 1639263387
Provider Name (Legal Business Name): MSA INTERNAL MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 BOULEVARD N.E. SUITE 324
ATLANTA GA
30312-1283
US

IV. Provider business mailing address

340 BOULEVARD N.E. SUITE 324
ATLANTA GA
30312-1283
US

V. Phone/Fax

Practice location:
  • Phone: 404-523-1864
  • Fax: 404-521-9261
Mailing address:
  • Phone: 404-523-1864
  • Fax: 404-521-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number053811
License Number StateGA

VIII. Authorized Official

Name: DR. MARIANNE SANCHEZ
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 404-523-1864