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General NPI Number Information
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NPI Number | 1740491257
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Entity Type | Organization
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Legal Business Name | MARIETTA HEALTHCARE ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2759 DELK RD SE SUITE 101
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City | MARIETTA
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State | GA
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Zip | 30067-8847
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Country | US
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Telephone | 770-792-0927
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6881
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City | MARIETTA
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State | GA
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Zip | 30065-0881
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Country | US
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Telephone | 770-792-0927
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Fax | 770-792-7893
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Authorized Official
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Title or Position | MANAGING MEMBER OF LLC
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Name | NELSON E MEDRANO
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Credential |
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Telephone | 770-792-0927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 7142
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 022067
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 8031
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License Number State | GA
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