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General NPI Number Information
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NPI Number | 1023059581
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Entity Type | Individual
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Provider Name | BRENDA L MARINO MD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 677 CHURCH ST HOSPITAL BASED ONLY KENNESTONE WELLSTAR
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City | MARIETTA
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State | GA
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Zip | 30060
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Country | US
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Telephone | 770-779-3603
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Fax | 770-793-9925
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Provider Business Mailing Address
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Address Line | PO BOX 4214
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City | MARIETTA
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State | GA
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Zip | 30061
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Country | US
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Telephone | 770-427-4800
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Fax | 770-427-3653
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 016392
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License Number State | GA
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