Healthcare Provider Details

I. General information

NPI: 1265687479
Provider Name (Legal Business Name): JOSEPH MARENO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 COLLIER RD NW SUITE 4025
ATLANTA GA
30309-1796
US

IV. Provider business mailing address

95 COLLIER RD NW SUITE 4025
ATLANTA GA
30309-1796
US

V. Phone/Fax

Practice location:
  • Phone: 404-574-5820
  • Fax: 404-574-5821
Mailing address:
  • Phone: 404-574-5820
  • Fax: 404-574-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME101083
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number062060
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: