Healthcare Provider Details

I. General information

NPI: 1891893806
Provider Name (Legal Business Name): ANTHONY MARZANO AA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 HIGHWAY 54 W
FAYETTEVILLE GA
30214-4526
US

IV. Provider business mailing address

2310 N PATTERSON ST BLDG C
VALDOSTA GA
31602-2500
US

V. Phone/Fax

Practice location:
  • Phone: 770-719-7000
  • Fax:
Mailing address:
  • Phone: 229-244-6852
  • Fax: 229-242-2385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number003003
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: