Provider Demographics
NPI:1215946140
Name:MARIONNEAUX, RALPH DAREN (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:DAREN
Last Name:MARIONNEAUX
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 1:415 BROCKMAN MCCLIMON RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-6608
Mailing Address - Country:US
Mailing Address - Phone:864-989-1432
Mailing Address - Fax:864-989-1462
Practice Address - Street 1:415 BROCKMAN MCCLIMON RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-6608
Practice Address - Country:US
Practice Address - Phone:864-989-1432
Practice Address - Fax:864-989-1462
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47621207Q00000X
SC40711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00886784BMedicaid
GAG26716Medicare UPIN
GA08BBVFLMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER