Healthcare Provider Details

I. General information

NPI: 1487736534
Provider Name (Legal Business Name): MARTHA R. MARZETTA RN, ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 JOHNSON FERRY RD SUITE 500
ATLANTA GA
30342-1631
US

IV. Provider business mailing address

960 JOHNSON FERRY RD SUITE 500
ATLANTA GA
30342-1631
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-0006
  • Fax: 404-851-1316
Mailing address:
  • Phone: 404-257-0006
  • Fax: 404-851-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number695301
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: