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General NPI Number Information
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NPI Number | 1063462539
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Entity Type | Individual
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Provider Name | MARCIA MCDONNELL HOLSTAD DSN, RN, C, FNP
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Gender | Female
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 341 PONCE DE LEON AVE
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City | ATLANTA
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State | GA
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Zip | 30308
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Country | US
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Telephone | 404-616-9824
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Fax |
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Provider Business Mailing Address
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Address Line | 3020 BOLES FARM LN
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City | DULUTH
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State | GA
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Zip | 30096-5440
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Country | US
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Telephone | 770-622-9202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN048542
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License Number State | GA
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