Provider Demographics
NPI:1679730501
Name:MARIETTA NEONATOLOGY, P.C.
Entity Type:Organization
Organization Name:MARIETTA NEONATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-427-4800
Mailing Address - Street 1:PO BOX 4214
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061-4214
Mailing Address - Country:US
Mailing Address - Phone:770-427-4800
Mailing Address - Fax:
Practice Address - Street 1:800 KENNESAW AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1051
Practice Address - Country:US
Practice Address - Phone:770-427-4800
Practice Address - Fax:770-427-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty