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General NPI Number Information
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NPI Number | 1578690483
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Entity Type | Individual
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Provider Name | MARIBELLE VERDIALES MD
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 924 W SPRING ST
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City | MONROE
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State | GA
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Zip | 30655-1751
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Country | US
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Telephone | 770-266-0935
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Fax | 770-266-0931
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Provider Business Mailing Address
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Address Line | 924 W SPRING ST
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City | MONROE
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State | GA
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Zip | 30655-1751
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Country | US
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Telephone | 770-266-0935
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Fax | 770-266-0931
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 061871
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License Number State | GA
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