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General NPI Number Information
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NPI Number | 1891719076
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Entity Type | Individual
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Provider Name | MARRE PATRICE HENRY P.A-C
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2675 N DECATUR RD SUITE 506
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City | DECATUR
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State | GA
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Zip | 30033-6131
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Country | US
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Telephone | 404-299-1679
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Fax |
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Provider Business Mailing Address
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Address Line | 1126 PRESTON CREEK DR
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City | MCDONOUGH
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State | GA
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Zip | 30253-8977
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Country | US
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Telephone | 678-583-5139
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 004592
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License Number State | GA
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