Healthcare Provider Details

I. General information

NPI: 1447919626
Provider Name (Legal Business Name): MARLEN ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-4201
US

IV. Provider business mailing address

155 CLAIREMONT AVE APT 442
DECATUR GA
30030-2644
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN285909
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1084237
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN285909
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: