Provider Demographics
NPI:1770818502
Name:MARIAN T EBRON, MD INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:MARIAN T EBRON, MD INTERNAL MEDICINE PC
Other - Org Name:MARIAN T EBRON, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:EBRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-738-7557
Mailing Address - Street 1:2047 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4178
Mailing Address - Country:US
Mailing Address - Phone:706-738-7557
Mailing Address - Fax:706-738-7526
Practice Address - Street 1:2047 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4178
Practice Address - Country:US
Practice Address - Phone:706-738-7557
Practice Address - Fax:706-738-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041783209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes209800000XAllopathic & Osteopathic PhysiciansLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000709684BMedicaid
GA11BDSFDOtherMEDICARE
GA11BDSFDOtherMEDICARE