Provider Demographics
NPI:1891710679
Name:MARIETTA OB GYN AFFILIATES, P.A.
Entity Type:Organization
Organization Name:MARIETTA OB GYN AFFILIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMOLINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-422-8505
Mailing Address - Street 1:699 CHURCH ST NE
Mailing Address - Street 2:STE 220
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1116
Mailing Address - Country:US
Mailing Address - Phone:770-422-8509
Mailing Address - Fax:770-424-7449
Practice Address - Street 1:699 CHURCH ST NE
Practice Address - Street 2:STE 220
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1116
Practice Address - Country:US
Practice Address - Phone:770-422-8509
Practice Address - Fax:770-424-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300020849BMedicaid
GA300020849BMedicaid