Healthcare Provider Details

I. General information

NPI: 1972605624
Provider Name (Legal Business Name): RENEE E CORLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 SOUTHCREST DR STE 200
STOCKBRIDGE GA
30281-6116
US

IV. Provider business mailing address

653 ROBERTS DR SUITE A
RIVERDALE GA
30274-2959
US

V. Phone/Fax

Practice location:
  • Phone: 770-474-5302
  • Fax:
Mailing address:
  • Phone: 770-907-8400
  • Fax: 770-907-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number033302
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: