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General NPI Number Information
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NPI Number | 1053862169
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Entity Type | Organization
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Legal Business Name | REGIONAL MARIETTA MEDICAL CENTER
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 1469 ROSWELL RD
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City | MARIETTA
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State | GA
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Zip | 30062-3668
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Country | US
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Telephone | 770-509-2433
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Fax |
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Provider Business Mailing Address
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Address Line | 293 SHILOH MANOR DR
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City | MARIETTA
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State | GA
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Zip | 30066-5913
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Country | US
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Telephone | 765-326-0148
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. RICHARD K EMERY
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Credential | DC
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Telephone | 770-509-2433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | RN 224384
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License Number State | GA
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