Fedack, Maryann Johnston
Fedack, Maryann Johnston is an individual health care provider with primary practice located at 1111 Alderman Drive Ste. 250, Alpharetta GA 30005. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Fedack, Maryann Johnston can be contacted via phone (678) 527-1555.Contact Information
Primary practice address
1111 Alderman Drive Ste. 250
Alpharetta GA 30005
Phone: (678) 527-1555
Fax: (678) 527-1559
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 057370 | Georgia |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 54370 | Georgia |
Profile Details
| NPI number | 1194780064 |
|---|---|
| LBN Legal business name | Fedack, Maryann Johnston |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 20th, 2006 |
| Last updated | Jun 5th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194780064 | NPPES |
| Georgia | MEDICAID | 003122405B |
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