Healthcare Provider Details

I. General information

NPI: 1265477186
Provider Name (Legal Business Name): MARION MCCAULEY EARNHARDT P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 NEW PEACHTREE RD SUITE 202
CHAMBLEE GA
30341-3326
US

IV. Provider business mailing address

2650 GENTRY WALK CT
CUMMING GA
30041-7484
US

V. Phone/Fax

Practice location:
  • Phone: 678-672-2177
  • Fax:
Mailing address:
  • Phone: 770-722-1940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number003245
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: