Individual
MARISOL SAN INOCENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1001 FERNWOOD DR, MILLEDGEVILLE, GA 31061-5416
(478) 453-8100
Mailing address
PO BOX 669, MILLEDGEVILLE, GA 31059-0669
(478) 453-8100
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
047654
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000833566D
—
GA
Enumeration date
03/07/2006
Last updated
11/15/2011
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