Healthcare Provider Details

I. General information

NPI: 1770818502
Provider Name (Legal Business Name): MARIAN T EBRON, MD INTERNAL MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 CENTRAL AVE
AUGUSTA GA
30904-4178
US

IV. Provider business mailing address

2047 CENTRAL AVE
AUGUSTA GA
30904-4178
US

V. Phone/Fax

Practice location:
  • Phone: 706-738-7557
  • Fax: 706-738-7526
Mailing address:
  • Phone: 706-738-7557
  • Fax: 706-738-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License Number041783
License Number StateGA

VIII. Authorized Official

Name: DR. MARIAN T EBRON
Title or Position: PHYSICIAN
Credential:
Phone: 706-738-7557