Healthcare Provider Details

I. General information

NPI: 1154818102
Provider Name (Legal Business Name): ADAM ALBANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 CHURCH ST NE LOWR LEVEL
MARIETTA GA
30060-1101
US

IV. Provider business mailing address

355 TOWER RD NE STE 300
MARIETTA GA
30060-9408
US

V. Phone/Fax

Practice location:
  • Phone: 770-793-5186
  • Fax:
Mailing address:
  • Phone: 770-427-2457
  • Fax: 770-427-2706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number90012
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: