Provider Demographics
NPI:1225054216
Name:ORIG, MARIA JOCELYN (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JOCELYN
Last Name:ORIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 CLINIC AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117
Mailing Address - Country:US
Mailing Address - Phone:770-832-0429
Mailing Address - Fax:770-838-9108
Practice Address - Street 1:157 CLINIC AVE
Practice Address - Street 2:STE 203
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117
Practice Address - Country:US
Practice Address - Phone:770-832-0429
Practice Address - Fax:770-838-9108
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA044561207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000779369GMedicaid
GA202I395238OtherMEDICARE PTAN