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General NPI Number Information
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NPI Number | 1386918258
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Entity Type | Individual
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Provider Name | ELIZABETH E MARQUETTI IV MD,PHARMACY ,PHD
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Gender | Female
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 4 SWEETBRIAR DR # 4
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City | PALMETTO
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State | GA
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Zip | 30268-9408
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Country | US
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Telephone | 470-233-0982
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Fax |
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Provider Business Mailing Address
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Address Line | 4 SWEETBRIAR DR # 4
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City | PALMETTO
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State | GA
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Zip | 30268-9408
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Country | US
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Telephone | 470-233-0982
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Fax |
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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 | 207KI0005X
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Taxonomy Name | Clinical & Laboratory Immunology (Allergy & Immunology) Physician
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License Number | CCMA1022-7775
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License Number State | KS
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