Provider Demographics
NPI:1639263387
Name:MSA INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:MSA INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-523-1864
Mailing Address - Street 1:340 BOULEVARD N.E.
Mailing Address - Street 2:SUITE 324
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1283
Mailing Address - Country:US
Mailing Address - Phone:404-523-1864
Mailing Address - Fax:404-521-9261
Practice Address - Street 1:340 BOULEVARD N.E.
Practice Address - Street 2:SUITE 324
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1283
Practice Address - Country:US
Practice Address - Phone:404-523-1864
Practice Address - Fax:404-521-9261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053811207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH99076Medicare UPIN
GA11SCDLTMedicare ID - Type Unspecified