Provider Demographics
NPI:1972605624
Name:CORLEY, RENEE E (MD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:E
Last Name:CORLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:653 ROBERTS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2959
Mailing Address - Country:US
Mailing Address - Phone:770-907-8400
Mailing Address - Fax:770-907-8430
Practice Address - Street 1:1035 SOUTHCREST DR STE 200
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6116
Practice Address - Country:US
Practice Address - Phone:770-474-5302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1972605624OtherBCBSGA
GA00441955GMedicaid
GAF23190Medicare UPIN
GA08BBSQWMedicare PIN