MEDICARE: MARION & ASSOCIATES FAMILY CARE

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
1	261QM1300X	Multi-Specialty Clinic/Center
2	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1871225300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARION & ASSOCIATES FAMILY CARE

Provider Business Mailing Address
First Line	:	PO BOX 1395
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30058-1395
Country	:	US
Telephone Number	:	205-767-9992
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 PEACHTREE ST NE STE 100&200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2177
Country	:	US
Telephone Number	:	205-767-9992
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. PKANITA MARION
Credential	:	NP
Telephone Number	:	205-767-9992

Provider Enumeration Date	:	06/24/2022
Last Update Date	:	06/24/2022

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