Provider Demographics
NPI:1629066584
Name:GARRITY, MARIE E (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:E
Last Name:GARRITY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 JOHNSON FERRY RD
Mailing Address - Street 2:STE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1418
Mailing Address - Country:US
Mailing Address - Phone:404-497-1020
Mailing Address - Fax:404-252-1530
Practice Address - Street 1:875 JOHNSON FERRY RD
Practice Address - Street 2:STE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1418
Practice Address - Country:US
Practice Address - Phone:404-497-1020
Practice Address - Fax:404-252-1530
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0006187140Medicaid
GA000618714GMedicaid
GA000618714HMedicaid
GA000618714EMedicaid
GA000618714FMedicaid
GA202I115850Medicare PIN
GAF88276Medicare UPIN
GA000618714FMedicaid
GA000618714GMedicaid