Provider Demographics
NPI:1457344418
Name:ACOSTA, MARIA F (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:F
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 RT STANLEY SR PL
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:GA
Mailing Address - Zip Code:30436-5623
Mailing Address - Country:US
Mailing Address - Phone:912-526-9355
Mailing Address - Fax:912-526-8622
Practice Address - Street 1:110 RT STANLEY SR PL
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:GA
Practice Address - Zip Code:30436-5623
Practice Address - Country:US
Practice Address - Phone:912-526-9355
Practice Address - Fax:912-526-8622
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA745022716AMedicaid
GA745022716AMedicaid
GA202I118592OtherMEDICARE ID
GA11BDWVXMedicare ID - Type Unspecified