Healthcare Provider Details

I. General information

NPI: 1396285466
Provider Name (Legal Business Name): MARIE CARLINE DORLEUS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2782 COBB PKWY NW
KENNESAW GA
30152-3472
US

IV. Provider business mailing address

2782 COBB PKWY NW
KENNESAW GA
30152-3472
US

V. Phone/Fax

Practice location:
  • Phone: 770-420-1092
  • Fax:
Mailing address:
  • Phone: 770-420-1092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9328002
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9328002
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11978
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number296625
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: