Healthcare Provider Details

I. General information

NPI: 1841700382
Provider Name (Legal Business Name): MARNI BELL FEDERER NP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 GOVERNORS SQ STE B
PEACHTREE CITY GA
30269-4871
US

IV. Provider business mailing address

211 ROY RD
SHARPSBURG GA
30277-2584
US

V. Phone/Fax

Practice location:
  • Phone: 770-603-0123
  • Fax:
Mailing address:
  • Phone: 770-548-8807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN239041
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11012190
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN239041
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-157770
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2361712
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: