Marietta Medical Group

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

024225 Issued in GA

Legal business name

MARIETTA MEDICAL GROUP

Practice address

741 Chance Rd
Marietta, GA 30066-3711

Phone

(770) 977-5355

Fax

(770) 973-8497

NPI assigned

May 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Imani D. Vannoy, M.D.NPI 1376596783

Title

Doctor

Phone

(770) 977-5355

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Imani D. Vannoy, M.D.

  • Internal Medicine Physician
  • Marietta, GA
  • NPI 1376596783

  GA

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249862400000",
    "number": "1366497398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 CHANCE RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300663711",
            "telephone_number": "770-977-5355",
            "fax_number": "770-973-8497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 CHANCE RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300663711",
            "telephone_number": "770-977-5355",
            "fax_number": "770-973-8497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2009-08-10",
        "status": "A",
        "authorized_official_last_name": "VANNOY",
        "authorized_official_first_name": "IMANI",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "770-977-5355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "024225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000356617A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marietta Healthcare Associates, LLC
• Marietta Healthcare LLC
• Marietta Imaging, LLC
• Marietta Medical & Wellness
• Marietta Medical Associates LLC
• Marietta Medical Supplies Inc
• Marietta Neonatology, P.C.
• Marietta Neurology and Headache Center, PC
• Marietta Newborn Care LLC
• Marietta Northside Hospital Services Corp

• Primary Care Clinic/Center in Marietta, GA
• Providers in Marietta, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.