Individual
MARCELLA TOWNSEND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSA
Contact information
Practice address
203 HARBOR LNDG, ROSWELL, GA 30076
(912) 604-0905
(678) 243-5735
Mailing address
PO BOX 768873, ROSWELL, GA 30076-8211
(912) 604-0905
(678) 243-5735
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4411
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518472299
PROSOURCE SURGICAL ASSISTING, LLC
GA
Enumeration date
07/07/2014
Last updated
10/24/2018
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