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Individual

MARISA CHAVEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2400 MOUNT ZION PKWY, JONESBORO, GA 30236-2500
(770) 603-3634
Mailing address
2400 MOUNT ZION PKWY, JONESBORO, GA 30236-2500
(770) 603-3634

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
066008
GA
207V00000X
Obstetrics & Gynecology Physician
A106212
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003114009D
GA
Enumeration date
12/15/2008
Last updated
03/29/2022
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