Provider Demographics
NPI:1508051244
Name:MARIETTA MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:MARIETTA MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-630-9957
Mailing Address - Street 1:445 WINDY HILL RD SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7342
Mailing Address - Country:US
Mailing Address - Phone:770-431-9533
Mailing Address - Fax:770-431-9535
Practice Address - Street 1:445 WINDY HILL RD SE
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7342
Practice Address - Country:US
Practice Address - Phone:770-431-9533
Practice Address - Fax:770-431-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty