Provider Demographics
NPI:1497400857
Name:COLE, MARIANNE (MED)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 WATERFORD CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-4132
Mailing Address - Country:US
Mailing Address - Phone:770-714-6879
Mailing Address - Fax:
Practice Address - Street 1:1040 BARCLAY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-4621
Practice Address - Country:US
Practice Address - Phone:706-438-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional