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NPI Code Detail

MEDICARE: REAGAN OCHIENG MARIENGA PA

MEDICARE: REAGAN OCHIENG MARIENGA PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant9730GA
2363A00000XPhysician Assistant6152SC

General Provider Information

NPI Number : 1417583709
Entity Type Code : Individual
Provider Name (Legal Business Name) : REAGAN OCHIENG MARIENGA PA
Provider Business Mailing Address
First Line : 1670 CLAIRMONT RD
Second Line :
City : DECATUR
State : GA
Zip : 30033-4004
Country : US
Telephone Number : 404-321-6111
Fax Number :
Provider Business Practice Location Address
First Line : 1670 CLAIRMONT RD
Second Line :
City : DECATUR
State : GA
Zip : 30033-4004
Country : US
Telephone Number : 404-321-6111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2020
Last Update Date : 03/18/2026

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Directions to “ REAGAN OCHIENG MARIENGA PA” Practice Location

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