Healthcare Provider Details

I. General information

NPI: 1083871339
Provider Name (Legal Business Name): MARIETTA NEWBORN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PLAZA WAY SUITE E
MARIETTA GA
30060
US

IV. Provider business mailing address

4295 COUNTRY GARDEN WALK
KENNESAW GA
30152
US

V. Phone/Fax

Practice location:
  • Phone: 404-454-9716
  • Fax: 770-793-9260
Mailing address:
  • Phone: 770-235-2462
  • Fax: 770-974-3955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SN0000X
TaxonomyNeonatal Clinical Nurse Specialist
License NumberR047729
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberR065909
License Number StateGA

VIII. Authorized Official

Name: MRS. PATRICIA B HUNT
Title or Position: OWNER
Credential: NP
Phone: 770-235-2462