Provider Demographics
NPI:1023135134
Name:MARQUEZ, RAMON R (MD)
Entity type:Individual
Prefix:
First Name:RAMON
Middle Name:R
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 TARA BLVD # A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1503
Mailing Address - Country:US
Mailing Address - Phone:770-477-8573
Mailing Address - Fax:770-477-9045
Practice Address - Street 1:6911 TARA BLVD # A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1503
Practice Address - Country:US
Practice Address - Phone:770-477-8573
Practice Address - Fax:770-477-9045
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020458208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10033953OtherAMERIGROUP
GA10033953OtherAMERIGROUP
GA01BDGWDMedicare ID - Type Unspecified