Healthcare Provider Details

I. General information

NPI: 1528973443
Provider Name (Legal Business Name): CENTRO PRENATAL DE MARIETTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 AUSTELL RD STE 201
AUSTELL GA
30106-1153
US

IV. Provider business mailing address

3875 AUSTELL RD STE 201
AUSTELL GA
30106-1153
US

V. Phone/Fax

Practice location:
  • Phone: 678-918-9955
  • Fax: 678-433-0330
Mailing address:
  • Phone: 678-918-9955
  • Fax: 678-433-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ROSALBA GOMEZ
Title or Position: BUISNESS ADMINISTRATOR
Credential:
Phone: 678-492-8477