Healthcare Provider Details

I. General information

NPI: 1124184742
Provider Name (Legal Business Name): MARA RENEE FRANKLIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARA RENEE DAVIS

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 BARNETT SHOALS RD STE B
ATHENS GA
30605-2748
US

IV. Provider business mailing address

PO BOX 409
WATKINSVILLE GA
30677-0011
US

V. Phone/Fax

Practice location:
  • Phone: 706-543-6443
  • Fax: 706-543-8202
Mailing address:
  • Phone: 706-769-6469
  • Fax: 706-769-4402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004075
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: