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General NPI Number Information
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NPI Number | 1508494378
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Entity Type | Individual
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Provider Name | MICHAEL JOHN MARINO DO
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Gender | Male
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Dates
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Enumeration Date | 03/29/2020
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 1270 FRIENDSHIP RD STE 100
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City | BRASELTON
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State | GA
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Zip | 30517-5629
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Country | US
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Telephone | 770-536-9864
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Fax | 770-297-5023
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Provider Business Mailing Address
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Address Line | 1270 FRIENDSHIP RD STE 100
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City | BRASELTON
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State | GA
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Zip | 30517-5629
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Country | US
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Telephone | 770-536-9864
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Fax | 770-297-5023
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 105422
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License Number State | GA
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