Organization
G
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIETTA MILLER (ADMINISTRATOR)
(867) 388-1577
Entity
Organization
Contact information
Practice address
55 WHITCHER ST NE, MARIETTA, GA 30060-1155
(770) 427-7389
(770) 427-1492
Mailing address
55 WHITCHER ST NE, MARIETTA, GA 30060-1155
(770) 427-7389
(770) 427-1492
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN209845
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN209845
RN LICENSE
GA
Enumeration date
02/22/2017
Last updated
02/22/2017
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