Provider Demographics
NPI:1821234923
Name:RILEY, MARCIA GLENN (M D)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:GLENN
Last Name:RILEY
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 PEACHTREE ST NE STE A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-1421
Mailing Address - Country:US
Mailing Address - Phone:404-688-9300
Mailing Address - Fax:
Practice Address - Street 1:355 PHILIP BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8733
Practice Address - Country:US
Practice Address - Phone:404-688-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-20
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA28066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003132247EMedicaid