Healthcare Provider Details

I. General information

NPI: 1639580780
Provider Name (Legal Business Name): MARLA C GREEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7823 SPIVEY STATION BLVD # 360
JONESBORO GA
30236-2886
US

IV. Provider business mailing address

477 WINDSOR ST SW STE 309
ATLANTA GA
30312-2530
US

V. Phone/Fax

Practice location:
  • Phone: 770-741-1751
  • Fax: 770-741-1755
Mailing address:
  • Phone: 404-688-9202
  • Fax: 404-880-0838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN196523
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: