Healthcare Provider Details

I. General information

NPI: 1104091222
Provider Name (Legal Business Name): MARLENA CELESTE CAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 UPPER RIVERDALE RD
RIVERDALE GA
30274
US

IV. Provider business mailing address

235 PEACHTREE ST NE NORTH TOWER, SUITE 2100
ATLANTA GA
30303-1401
US

V. Phone/Fax

Practice location:
  • Phone: 770-994-9326
  • Fax: 770-994-4747
Mailing address:
  • Phone: 770-994-9326
  • Fax: 770-994-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number060806
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: