Healthcare Provider Details

I. General information

NPI: 1679730501
Provider Name (Legal Business Name): MARIETTA NEONATOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KENNESAW AVE NW SUITE 200
MARIETTA GA
30060-1051
US

IV. Provider business mailing address

PO BOX 4214
MARIETTA GA
30061-4214
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-4800
  • Fax: 770-427-3610
Mailing address:
  • Phone: 770-427-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JOYCE C BRACY
Title or Position: OFFICE MANAGER
Credential:
Phone: 770-427-4800