Individual
MARJORIE DRIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
805 CAMPBELL HILL ST NW, MARIETTA, GA 30060-1144
(404) 756-6866
Mailing address
868 YORK SVENUE, ATLANTA, GA 30310
(404) 756-8738
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5923
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003140769C
—
GA
Enumeration date
09/12/2012
Last updated
07/09/2014
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