Provider Demographics
NPI:1588318711
Name:MARQUEZ FAMILY MEDICAL CENTER LLC
Entity type:Organization
Organization Name:MARQUEZ FAMILY MEDICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLIN
Authorized Official - Middle Name:YARED
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, MBA, FNP-BC
Authorized Official - Phone:678-585-4959
Mailing Address - Street 1:3840 PEACHTREE INDUSTRIAL BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5034
Mailing Address - Country:US
Mailing Address - Phone:678-585-4959
Mailing Address - Fax:470-395-9127
Practice Address - Street 1:3840 PEACHTREE INDUSTRIAL BLVD STE 250
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5034
Practice Address - Country:US
Practice Address - Phone:678-585-4959
Practice Address - Fax:470-395-9127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty