Provider Demographics
NPI:1932232790
Name:MARILYN DIGAMON BELTRAN
Entity Type:Organization
Organization Name:MARILYN DIGAMON BELTRAN
Other - Org Name:NORTHEAST INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGAMON BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-267-9484
Mailing Address - Street 1:333 ALCOVY ST
Mailing Address - Street 2:STE 8
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2180
Mailing Address - Country:US
Mailing Address - Phone:770-267-9484
Mailing Address - Fax:770-267-1600
Practice Address - Street 1:333 ALCOVY ST
Practice Address - Street 2:STE 8
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2180
Practice Address - Country:US
Practice Address - Phone:770-267-9484
Practice Address - Fax:770-267-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027031173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1639254881OtherNPI
GA1265500862OtherNPI
GA1437131596OtherNPI