Healthcare Provider Details

I. General information

NPI: 1710930300
Provider Name (Legal Business Name): ADULT MEDICINE OF MARIETTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 CHURCH ST NE SUITE 250
MARIETTA GA
30060-7282
US

IV. Provider business mailing address

790 CHURCH ST NE SUITE 250
MARIETTA GA
30060-7282
US

V. Phone/Fax

Practice location:
  • Phone: 678-797-8201
  • Fax: 678-797-8259
Mailing address:
  • Phone: 678-797-8201
  • Fax: 678-797-8259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAM RHODEN
Title or Position: BILLING MANAGER
Credential: RN
Phone: 678-797-8201