Provider Demographics
NPI:1336301068
Name:MARI MEDICAL CARE LLC
Entity Type:Organization
Organization Name:MARI MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-971-8708
Mailing Address - Street 1:3260 NEW MACLAND RD BLDG 100
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-1741
Mailing Address - Country:US
Mailing Address - Phone:678-695-8073
Mailing Address - Fax:678-302-0565
Practice Address - Street 1:3260 NEW MACLAND RD
Practice Address - Street 2:BLDG 100
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-1741
Practice Address - Country:US
Practice Address - Phone:678-401-3943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003112939AMedicaid