Healthcare Provider Details

I. General information

NPI: 1992868236
Provider Name (Legal Business Name): MELANIE MARSHALL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 HEMBREE RD BUILDING B, SUITE 100
ROSWELL GA
30076-5721
US

IV. Provider business mailing address

527 SAINT BARBARAS LN NW
MARIETTA GA
30064-1450
US

V. Phone/Fax

Practice location:
  • Phone: 770-772-0695
  • Fax: 770-751-0409
Mailing address:
  • Phone: 404-271-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN132237
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: