Healthcare Provider Details

I. General information

NPI: 1417932567
Provider Name (Legal Business Name): LAURIE EILEEN BIVINS RN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURIE EILEEN MARSHALL RN, CPNP

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 DALLAS HWY SW STE C
MARIETTA GA
30064-2095
US

IV. Provider business mailing address

3515 DALLAS HWY SW STE C
MARIETTA GA
30064-2095
US

V. Phone/Fax

Practice location:
  • Phone: 770-943-9150
  • Fax: 770-218-0278
Mailing address:
  • Phone: 770-943-9150
  • Fax: 770-218-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number85069
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number094302
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: