Healthcare Provider Details

I. General information

NPI: 1982251500
Provider Name (Legal Business Name): MELVENIA W. MARABLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 SNAPFINGER WOODS DR
DECATUR GA
30035-3440
US

IV. Provider business mailing address

4229 SNAPFINGER WOODS DR
DECATUR GA
30035-3440
US

V. Phone/Fax

Practice location:
  • Phone: 404-286-9252
  • Fax: 404-286-9253
Mailing address:
  • Phone: 404-286-9252
  • Fax: 404-286-9253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW001968
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: