Provider Demographics
NPI:1578690483
Name:VERDIALES, MARIBELLE (MD)
Entity Type:Individual
Prefix:
First Name:MARIBELLE
Middle Name:
Last Name:VERDIALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIBELLE
Other - Middle Name:
Other - Last Name:VERDIALES-GOMEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:924 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-1751
Mailing Address - Country:US
Mailing Address - Phone:770-266-0935
Mailing Address - Fax:770-266-0931
Practice Address - Street 1:924 W SPRING ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-1751
Practice Address - Country:US
Practice Address - Phone:770-266-0935
Practice Address - Fax:770-266-0931
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061871207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300137757AMedicaid