Healthcare Provider Details

I. General information

NPI: 1952310500
Provider Name (Legal Business Name): MARTHA L ARELLANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365C CLIFTON RD NE SUITE 1152 C
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1365C CLIFTON RD NE SUITE 1152 C
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-1900
  • Fax: 404-778-4755
Mailing address:
  • Phone: 404-778-1900
  • Fax: 404-778-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number053698
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: