Healthcare Provider Details

I. General information

NPI: 1912325655
Provider Name (Legal Business Name): RHEUMATOLOGY ASSOCIATES OF MARIETTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHURCH ST NE
MARIETTA GA
30060-7220
US

IV. Provider business mailing address

700 CHURCH ST NE
MARIETTA GA
30060-7220
US

V. Phone/Fax

Practice location:
  • Phone: 770-420-1690
  • Fax:
Mailing address:
  • Phone: 770-420-1690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number69137
License Number StateGA

VIII. Authorized Official

Name: HELEN ELROD
Title or Position: MANAGER
Credential:
Phone: 770-420-1690