Marietta Healthcare

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

MARIETTA HEALTHCARE

Practice address

534 Flint TRL
Jonesboro, GA 30236-1316

Phone

(770) 792-0927

Fax

(770) 792-7893

NPI assigned

Dec 8, 2009

Organization subpart

No

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

Authorized official

Name

Nelson Medrano

Title

Clinic Director

Phone

(770) 792-0927

Specialties & licenses 1

Addresses

Other names 1

• Southern Healthcare Doing business as

Tax ID family

Marietta Healthcare2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Southern Healthcare Provider Group, LLC

  • Rehabilitation Chiropractor
  • Decatur, GA
  • NPI 1922273747
  NPD tax ID

Locations

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

{
    "created_epoch": "1260230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260230400000",
    "number": "1376872184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6881",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300650881",
            "telephone_number": "770-792-0927",
            "fax_number": "770-792-7893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "534 FLINT TRL",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302361316",
            "telephone_number": "770-792-0927",
            "fax_number": "770-792-7893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-08",
        "last_updated": "2009-12-08",
        "status": "A",
        "authorized_official_last_name": "MEDRANO",
        "authorized_official_first_name": "NELSON",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "770-792-0927"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mercy B Manga, NP-C
• Azad Mansouri, MD
• Michelle Maples, RN
• Roland K Mapp
• Eddra Y Marchand, MD
• Heather Markovitch
• Marnae Group, LLC
• Ramon R Marquez, MD
• Jennifer Angella Marrast Host, M.D.
• Marshall World Empire Coach/N.E.T.

• Chiropractor in Jonesboro, GA
• Providers in Jonesboro, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.