Healthcare Provider Details

I. General information

NPI: 1609183755
Provider Name (Legal Business Name): MARCIA YOUNKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 S MULBERRY ST D
JACKSON GA
30233-2474
US

IV. Provider business mailing address

140 BRIDGER POINT RD
FAYETTEVILLE GA
30215-5213
US

V. Phone/Fax

Practice location:
  • Phone: 404-915-3362
  • Fax: 770-631-1916
Mailing address:
  • Phone: 404-915-3362
  • Fax: 770-631-1916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN086363
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: