Healthcare Provider Details

I. General information

NPI: 1548702566
Provider Name (Legal Business Name): MARCIA MCGRATH-ENI N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 CLEVELAND AVE
EAST POINT GA
30344-3433
US

IV. Provider business mailing address

4702 CLARKS CREEK LN
ELLENWOOD GA
30294-6576
US

V. Phone/Fax

Practice location:
  • Phone: 404-761-0819
  • Fax: 404-768-2336
Mailing address:
  • Phone: 404-964-4704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN179820
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: