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General NPI Number Information
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NPI Number | 1689624397
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Entity Type | Individual
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Provider Name | WILLIAM A. MARBURY PAA
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 303 PARKWAY DR NE
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City | ATLANTA
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State | GA
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Zip | 30312-1212
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Country | US
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Telephone | 404-265-4520
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Fax | 404-265-3894
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Provider Business Mailing Address
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Address Line | 3955 CHIMNEY RIDGE CT
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City | ELLENWOOD
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State | GA
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Zip | 30294-1446
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Country | US
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Telephone | 404-849-9450
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 004644
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 004644
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License Number State | GA
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