Healthcare Provider Details

I. General information

NPI: 1669888665
Provider Name (Legal Business Name): MARIETTA SAUNDERS RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2471 SIERRA HEIGHTS DR
JONESBORO GA
30236-7248
US

IV. Provider business mailing address

2471 SIERRA HEIGHTS DR
JONESBORO GA
30236-7248
US

V. Phone/Fax

Practice location:
  • Phone: 770-880-1840
  • Fax: 248-850-7424
Mailing address:
  • Phone: 770-880-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN263311
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: