Provider Demographics
NPI:1134330749
Name:JOHARY, MARIELLE ARRIEH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIELLE
Middle Name:ARRIEH
Last Name:JOHARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIELLE
Other - Middle Name:LINETTE
Other - Last Name:ARRIEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:780 ARAN DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5129
Mailing Address - Country:US
Mailing Address - Phone:770-645-5044
Mailing Address - Fax:
Practice Address - Street 1:1320 CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4130
Practice Address - Country:US
Practice Address - Phone:770-730-8908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0438572085R0202X
GA43857208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA30BDJQVMedicare ID - Type UnspecifiedMEDICARE IDENTIFICATION