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General NPI Number Information
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NPI Number | 1932575438
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Entity Type | Organization
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Legal Business Name | MARION HARGETT
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 502 PRYOR ST SW
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City | ATLANTA
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State | GA
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Zip | 30312-2760
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Country | US
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Telephone | 770-843-3217
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Fax |
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Provider Business Mailing Address
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Address Line | 3814 BROOKFOREST TRACE
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City | DECATUR
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State | GA
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Zip | 30034
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Country | US
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Telephone | 770-593-3217
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARION ELAINE HARGETT
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Credential | BEHAVIOR CNAULTANT
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Telephone | 770-843-3217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 305S00000X
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License Number State | GA
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