Provider Demographics
NPI:1740491257
Name:MARIETTA HEALTHCARE ASSOCIATES, LLC
Entity type:Organization
Organization Name:MARIETTA HEALTHCARE ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEDRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-792-0927
Mailing Address - Street 1:PO BOX 6881
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30065-0881
Mailing Address - Country:US
Mailing Address - Phone:770-792-0927
Mailing Address - Fax:770-792-7893
Practice Address - Street 1:2759 DELK RD SE
Practice Address - Street 2:SUITE 101
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8847
Practice Address - Country:US
Practice Address - Phone:770-792-0927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7142111N00000X
GA8031111N00000X
GA022067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty