Healthcare Provider Details

I. General information

NPI: 1932232790
Provider Name (Legal Business Name): MARILYN DIGAMON BELTRAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 ALCOVY ST STE 8
MONROE GA
30655-2180
US

IV. Provider business mailing address

333 ALCOVY ST STE 8
MONROE GA
30655-2180
US

V. Phone/Fax

Practice location:
  • Phone: 770-267-9484
  • Fax: 770-267-1600
Mailing address:
  • Phone: 770-267-9484
  • Fax: 770-267-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number027031
License Number StateGA

VIII. Authorized Official

Name: DR. MARILYN DIGAMON BELTRAN
Title or Position: PRESIDENT CEO
Credential: MD
Phone: 770-267-9484