Healthcare Provider Details

I. General information

NPI: 1932149853
Provider Name (Legal Business Name): MARICELIS H ARMSTRONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARICELIS HERNANDEZ

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 MULKEY RD STE 100
AUSTELL GA
30106
US

IV. Provider business mailing address

1965 NORTH PARK PL
ATLANTA GA
30339
US

V. Phone/Fax

Practice location:
  • Phone: 770-948-3774
  • Fax: 770-739-9609
Mailing address:
  • Phone: 770-952-8612
  • Fax: 770-618-8075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number050337
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: