MARIETTA MEDICAL GROUP (NPI# 1366497398) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366497398 |
| Entity Type | Organization |
| Organization Name | MARIETTA MEDICAL GROUP |
| Practice Address |
741 Chance Rd Marietta GA 30066-3711 |
| Practice Telephone | 7709775355 |
| Practice Fax Number | 7709738497 |
| Mailing Telephone | 7709775355 |
| Mailing Fax Number | 7709738497 |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2009-08-10 |
| Authorized Official Name | DR. IMANI D. VANNOY (DOCTOR) |
| Authorized Official Telephone | 7709775355 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
024225 | GA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000356617A | 05 |
| Street Address |
741 CHANCE RD |
| City | MARIETTA |
| State | GA |
| Zip Code | 30066-3711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376596783 | Imani D. Vannoy | Internal Medicine | 741 Chance Rd, Marietta, GA 30066-3711 | 2006-05-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598253684 | Comfort Community Center, LLC | Skilled Nursing Facility | 2440 Sandy Plains Road, Blvd 21, Suite 100, Marietta, GA 30066 | 2018-04-25 |
| 1538681994 | Passionate Care | In Home Supportive Care | 1110 Renfro Ln., Marietta, GA 30066 | 2017-07-07 |
| 1437510443 | Steven Caras | Internal Medicine | 2682 Bonaire Terrace, Marietta, GA 30066 | 2016-03-18 |
| 1275918781 | Latifat Bolajoko Asemota | Nurse Practitioner | 410 Nottingham Dr, Marietta, GA 30066 | 2015-07-26 |
| 1497094205 | Changing Phases Behavioral Support, Inc | Internal Medicine | 3655 Canton Rd Ste 201, Marietta, GA 30066 | 2013-02-14 |
| 1659618916 | Alison Nicole Sims | Occupational Therapist | 2465 Canopy Drive, Marietta, GA 30066 | 2013-01-07 |
| 1790044907 | Antoine Jose Davenport | Massage Therapist | 4686 Jamerson Creek Dr, Marietta, GA 30066 | 2012-05-08 |
| 1174898548 | Angel Elizabeth Nofziger | Nurse Practitioner | 3750 Palladian Village Dr Ste 300, Marietta, GA 30066 | 2012-03-18 |
| 1912298019 | Nancy Jean Slack | Pharmacist | 2833 Canton Road, Marietta, GA 30066 | 2011-04-22 |
| 1336456078 | Mario B Miller Sr. | Chiropractor | 50 Barrett Parkway, Suite 3005#126, Marietta, GA 30066 | 2010-09-01 |
| Find all providers in zip 30066 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043861545 | Careatc | Clinic/Center | 2130 Northwest Pkwy Se Ste H, Marietta, GA 30067-9307 | 2019-09-25 |
| 1205388980 | Careatc-quicktrip Atlanta-glenridge | Clinic/Center | 2130 Northwest Pkwy Se, Suite H, Marietta, GA 30067-9307 | 2016-10-28 |
| 1083071773 | Irshad Syed Md LLC | Clinic/Center | 2382 Monte Villa Cts, Marietta, GA 30062-2899 | 2016-01-26 |
| 1144500117 | Ann Drake Thomas M.d.,p.c. | Clinic/Center | 670 Canton Rd Ne, Suite A, Marietta, GA 30060-8952 | 2011-08-23 |
| 1194047050 | Cobb Pediatrics, P.C. | Clinic/Center | 410 Villa Rica Way Sw, Marietta, GA 30064-5741 | 2010-02-19 |
| 1255562757 | Williams Wellness Center | Clinic/Center | 2799 Delk Rd Se, Suite 100, Marietta, GA 30067-6247 | 2009-07-31 |
| 1871752410 | Pearl Medical & Associates, LLC | Clinic/Center | 2550 Windy Hill Rd Se Ste 109, Marietta, GA 30067-8607 | 2008-06-09 |
| 1437668548 | Health and Spine Clinic Corp | Clinic/Center | 2475 Windy Hill Rd Se, Marietta, GA 30067-8604 | 2017-09-21 |
| 1003356361 | Proactive Physicians of Marietta, PC | Clinic/Center | 790 Church St Ne, Suite 220, Marietta, GA 30060-7282 | 2017-03-06 |
| 1891234118 | Kennestone Family Medicine | Clinic/Center | 72 Plaza Way Nw, Marietta, GA 30060-1104 | 2017-02-20 |
| Find all providers in MARIETTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.