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General NPI Number Information
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NPI Number | 1083871339
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Entity Type | Organization
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Legal Business Name | MARIETTA NEWBORN CARE LLC
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 50 PLAZA WAY SUITE E
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City | MARIETTA
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State | GA
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Zip | 30060
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Country | US
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Telephone | 404-454-9716
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Fax | 770-793-9260
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Provider Business Mailing Address
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Address Line | 4295 COUNTRY GARDEN WALK
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City | KENNESAW
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State | GA
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Zip | 30152
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Country | US
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Telephone | 770-235-2462
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Fax | 770-974-3955
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PATRICIA B HUNT
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Credential | NP
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Telephone | 770-235-2462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SN0000X
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Taxonomy Name | Neonatal Clinical Nurse Specialist
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License Number | R047729
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | R065909
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License Number State | GA
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