Organization
MARIETTA MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IMANI D. VANNOY M.D. (DOCTOR)
(770) 977-5355
Entity
Organization
Contact information
Practice address
741 CHANCE RD, MARIETTA, GA 30066-3711
(770) 977-5355
(770) 973-8497
Mailing address
741 CHANCE RD, MARIETTA, GA 30066-3711
(770) 977-5355
(770) 973-8497
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
024225
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000356617A
—
GA
Enumeration date
05/25/2006
Last updated
08/10/2009
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