MEDICARE: MRS. TARA LEIGH MARCUS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN139669	GA

General Provider Information

NPI Number	:	1538273446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA LEIGH MARCUS FNP

Provider Business Mailing Address
First Line	:	4940 N RIVER DR
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-9495
Country	:	US
Telephone Number	:	678-455-9362
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400-C OLD MILTON PARKWAY
Second Line	:	SUITE 545
City	:	ALPHARETTA
State	:	GA
Zip	:	30004
Country	:	US
Telephone Number	:	770-751-0800
Fax Number	:	770-751-7198

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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