Healthcare Provider Details

I. General information

NPI: 1144019662
Provider Name (Legal Business Name): DR. MARY MARGARET MARATOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 LANEY WALKER BOULEVARD AE 3046
AUGUSTA GA
30912
US

IV. Provider business mailing address

1459 LANEY WALKER BOULEVARD AE 3046
AUGUSTA GA
30912
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-7005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17525
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: