Provider Demographics
NPI:1770218505
Name:THE MARLEY-MIRANDA GROUP, INC
Entity Type:Organization
Organization Name:THE MARLEY-MIRANDA GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAYLER
Authorized Official - Middle Name:ALYSE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:833-885-4247
Mailing Address - Street 1:980 HOWELL MILL RD NW UNIT 1201
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-5966
Mailing Address - Country:US
Mailing Address - Phone:833-885-4247
Mailing Address - Fax:
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:833-885-4247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty