Provider Demographics
NPI:1114212552
Name:MARIS, GABRIELLA ELIESE (MD)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:ELIESE
Last Name:MARIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-4180
Mailing Address - Country:US
Mailing Address - Phone:770-968-6464
Mailing Address - Fax:770-968-6455
Practice Address - Street 1:1000 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-4180
Practice Address - Country:US
Practice Address - Phone:770-968-6464
Practice Address - Fax:770-968-6455
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451019207Q00000X
GA073819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine