Marietta Medical Group

LBN: Marietta Medical Group
Marietta Medical Group is an health care organization with primary practice located at 741 Chance Rd , Marietta GA 30066-3711. The organization recently has only one registered license in Ambulatory Health Care Facilities / Primary Care, which is considered as the primary health care specialty. Marietta Medical Group can be contacted via phone (770) 977-5355, or through Vannoy, Imani D. via phone (770) 977-5355.

Contact Information

Primary practice address
741 Chance Rd Marietta GA 30066-3711
Phone: (770) 977-5355
Fax: (770) 973-8497
Website:
Map and Directions
Authorized official contact:
Name: Vannoy, Imani D. Doctor of Medicine (MD)
Phone: (770) 977-5355

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Primary Care 261QP2300X 024225 Georgia

Profile Details

NPI number 1366497398
LBN Legal business name Marietta Medical Group
DBA Doing business as
Authorized official Vannoy, Imani D. Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date May 25th, 2006
Last updated Aug 10th, 2009 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366497398 NPPES
Georgia MEDICAID 000356617A

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