Provider Demographics
NPI:1528013943
Name:GADEA, MARISA R (MD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:R
Last Name:GADEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:RAQUEL
Other - Last Name:GADEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1121 JOHNSON FERRY RD
Mailing Address - Street 2:STE 220
Mailing Address - City:MARLETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068
Mailing Address - Country:US
Mailing Address - Phone:770-977-0094
Mailing Address - Fax:770-509-5177
Practice Address - Street 1:1121 JOHNSON FERRY RD
Practice Address - Street 2:STE 220
Practice Address - City:MARLETTA
Practice Address - State:GA
Practice Address - Zip Code:30068
Practice Address - Country:US
Practice Address - Phone:770-977-0094
Practice Address - Fax:770-509-5177
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041802208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics