Healthcare Provider Details

I. General information

NPI: 1780033118
Provider Name (Legal Business Name): KATHY MARSHALL RNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 BROOKSTONE CENTRE PKWY
COLUMBUS GA
31904-4501
US

IV. Provider business mailing address

39 OAK HILL CT
NEWNAN GA
30265-2392
US

V. Phone/Fax

Practice location:
  • Phone: 706-322-1700
  • Fax:
Mailing address:
  • Phone: 770-683-7873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN093636
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: