Healthcare Provider Details

I. General information

NPI: 1861171373
Provider Name (Legal Business Name): MARCIA GELLINEAU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4063 LAUREL BEND DR
SNELLVILLE GA
30039-4125
US

IV. Provider business mailing address

4063 LAUREL BEND DR
SNELLVILLE GA
30039-4125
US

V. Phone/Fax

Practice location:
  • Phone: 404-388-6780
  • Fax:
Mailing address:
  • Phone: 404-388-6780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN149094
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: