Healthcare Provider Details

I. General information

NPI: 1083061808
Provider Name (Legal Business Name): KARL MARETH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2016
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 MOUNTAINSIDE VILLAGE PKWY BLDG 500
JASPER GA
30143-8694
US

IV. Provider business mailing address

3280 HOWELL MILL RD NW # T-100
ATLANTA GA
30327-4111
US

V. Phone/Fax

Practice location:
  • Phone: 706-253-7340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME134605
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number92309
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number34875
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: