Individual
BRENDA L MARINO
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
677 CHURCH ST, HOSPITAL BASED ONLY KENNESTONE WELLSTAR, MARIETTA, GA 30060
(770) 779-3603
(770) 793-9925
Mailing address
PO BOX 4214, MARIETTA, GA 30061
(770) 427-4800
(770) 427-3653
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
016392
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00088646B
—
GA
Enumeration date
06/08/2006
Last updated
07/08/2007
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