Provider Demographics
NPI:1386918258
Name:MARQUETTI, ELIZABETH E IV (MD,PHARMACY ,PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:E
Last Name:MARQUETTI
Suffix:IV
Gender:F
Credentials:MD,PHARMACY ,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SWEETBRIAR DR # 4
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-9408
Mailing Address - Country:US
Mailing Address - Phone:470-233-0982
Mailing Address - Fax:
Practice Address - Street 1:4 SWEETBRIAR DR # 4
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-9408
Practice Address - Country:US
Practice Address - Phone:470-233-0982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSCCMA1022-7775207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA371-000-08-015-H01-PMedicare UPIN