Provider Demographics
NPI:1376586347
Name:OWEN, MARION K (MD)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:K
Last Name:OWEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARION
Other - Middle Name:HANSON
Other - Last Name:KAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:402 W PONCE DE LEON AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2443
Mailing Address - Country:US
Mailing Address - Phone:404-377-9010
Mailing Address - Fax:404-935-0254
Practice Address - Street 1:402 W PONCE DE LEON AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2443
Practice Address - Country:US
Practice Address - Phone:404-377-9010
Practice Address - Fax:404-935-0254
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
511I080104Medicare UPIN
GA08BBQNFMedicare ID - Type UnspecifiedMEDICARE NUMBER