Healthcare Provider Details

I. General information

NPI: 1891710679
Provider Name (Legal Business Name): MARIETTA OB GYN AFFILIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 CHURCH ST NE STE 220
MARIETTA GA
30060-1116
US

IV. Provider business mailing address

699 CHURCH ST NE STE 220
MARIETTA GA
30060-1116
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-8509
  • Fax: 770-424-7449
Mailing address:
  • Phone: 770-422-8509
  • Fax: 770-424-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MARILYN B SMOLINSKI
Title or Position: ADMINISTRATOR
Credential:
Phone: 770-422-8505