Healthcare Provider Details

I. General information

NPI: 1356159107
Provider Name (Legal Business Name): MARIE WITCHER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 MORNINGSIDE DR
PERRY GA
31069-2905
US

IV. Provider business mailing address

1117 MORNINGSIDE DR
PERRY GA
31069-2905
US

V. Phone/Fax

Practice location:
  • Phone: 478-287-6049
  • Fax: 478-224-1646
Mailing address:
  • Phone: 478-287-6049
  • Fax: 478-224-1646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP254416
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: