Provider Demographics
NPI:1528045655
Name:CHETTA, MARC ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:ANTHONY
Last Name:CHETTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 BARRON DR
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-5501
Mailing Address - Country:US
Mailing Address - Phone:706-754-1011
Mailing Address - Fax:
Practice Address - Street 1:480 BARRON DR
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-5501
Practice Address - Country:US
Practice Address - Phone:706-754-1011
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035025207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00474042AMedicaid
GA93BDBDMMedicare ID - Type Unspecified
GAB62561Medicare UPIN