Organization
MARIPOSA MEDICAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LACHUNNA BRYANT (MANAGER)
(770) 676-0831
Entity
Organization
Contact information
Practice address
767 CONCORD RD SE, SMYRNA, GA 30082-2625
(678) 305-1700
Mailing address
767 CONCORD RD SE, SMYRNA, GA 30082-2625
(678) 305-1700
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194707398
INDIVIDUAL NPI
GA
Enumeration date
10/13/2020
Last updated
10/13/2020
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