Healthcare Provider Details

I. General information

NPI: 1689598146
Provider Name (Legal Business Name): MARIANA MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 LAWRENCEVILLE SUWANEE RD STE A3
SUWANEE GA
30024-7488
US

IV. Provider business mailing address

280 WILDCAT LAKE DR
LAWRENCEVILLE GA
30043-2992
US

V. Phone/Fax

Practice location:
  • Phone: 470-589-1878
  • Fax: 470-870-1771
Mailing address:
  • Phone: 470-589-1878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: