Healthcare Provider Details

I. General information

NPI: 1821234923
Provider Name (Legal Business Name): MARCIA GLENN RILEY M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2008
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 PHILIP BLVD
LAWRENCEVILLE GA
30046-8733
US

IV. Provider business mailing address

241 PEACHTREE ST NE STE A
ATLANTA GA
30303-1421
US

V. Phone/Fax

Practice location:
  • Phone: 404-688-9300
  • Fax:
Mailing address:
  • Phone: 404-688-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28066
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: