Provider Demographics
NPI:1831384478
Name:EMMONS, ARLENE RENEE (MD)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:RENEE
Last Name:EMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1603
Mailing Address - Country:US
Mailing Address - Phone:404-763-4040
Mailing Address - Fax:404-763-4008
Practice Address - Street 1:535 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1603
Practice Address - Country:US
Practice Address - Phone:404-763-4040
Practice Address - Fax:404-763-4008
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0581712083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA058171OtherMEDICAL LICENSE
FE0202539OtherDEA - FEDERAL