Individual
MARYANN JOHNSTON FEDACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1111 ALDERMAN DRIVE, STE. 250, ALPHARETTA, GA 30005
(678) 527-1555
(678) 527-1559
Mailing address
1111 ALDERMAN DRIVE, STE. 250, ALPHARETTA, GA 30005
(678) 527-1555
(678) 527-1559
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
057370
GA
208000000X
Pediatrics Physician
Primary
54370
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003122405B
—
GA
Enumeration date
04/20/2006
Last updated
06/05/2018
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