Healthcare Provider Details

I. General information

NPI: 1407820483
Provider Name (Legal Business Name): LUKE KEITH MARONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GLENLAKE PKWY
SANDY SPRINGS GA
30328-3473
US

IV. Provider business mailing address

3495 PIEDMONT RD NE
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 470-620-1343
  • Fax:
Mailing address:
  • Phone: 470-620-1343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD422385
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD422385
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: