Provider Demographics
NPI:1982790531
Name:SANCHEZ, MARIANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:
Last Name:SANCHEZ
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 1:950 SANDERS RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5960
Mailing Address - Country:US
Mailing Address - Phone:770-442-9016
Mailing Address - Fax:770-442-0193
Practice Address - Street 1:950 SANDERS ROAD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5960
Practice Address - Country:US
Practice Address - Phone:770-442-9016
Practice Address - Fax:770-442-0193
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053811207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA569087157BMedicaid
GA11SCDLTMedicare ID - Type Unspecified
GA569087157BMedicaid