Basic Information
| Provider Information | |||||||||
| NPI: | 1942226774 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARINE | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2655 NORTHWINDS PKWY | ||||||||
| Address2: | |||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300092280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705221890 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | HAZARD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 417019466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064877510 | ||||||||
| FaxNumber: | 6064396793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 14996 | SC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD00042252 | WA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 0101049589 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 34764 | KY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 64992043 | 05 | KY | MEDICAID | 2044122 | 05 | WA | MEDICAID | P00139020 | 01 | VA | RAILROAD MEDICARE | OTHER | 010048257 | 05 | VA | MEDICAID | 421768 | 01 | VA | SOUTHERN HEALTH | OTHER | 340447 | 01 | WA | LABOR & INDUSTRIES | OTHER | 102046 | 01 | VA | ANTHEM | OTHER |