Healthcare Provider Details

I. General information

NPI: 1902267123
Provider Name (Legal Business Name): MARJANI JEAN-PHILIPPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 07/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 HIGHWAY 54 W SUITE 220
FAYETTEVILLE GA
30214-4550
US

IV. Provider business mailing address

1279 HIGHWAY 54 W SUITE 220
FAYETTEVILLE GA
30214-4550
US

V. Phone/Fax

Practice location:
  • Phone: 770-991-2200
  • Fax: 770-716-8672
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN217045
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: