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General NPI Number Information
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NPI Number | 1952083321
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Entity Type | Individual
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Provider Name | MARJORIE L MCDERMOTT
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Gender | Female
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Dates
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Enumeration Date | 08/03/2023
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 1401 JOHNSON FERRY RD STE 390
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City | MARIETTA
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State | GA
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Zip | 30062-9100
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Country | US
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Telephone | 470-250-1492
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Fax | 470-235-7311
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Provider Business Mailing Address
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Address Line | 3734 FOX HILLS DR SE
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City | MARIETTA
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State | GA
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Zip | 30067-4261
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Country | US
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Telephone | 240-408-1303
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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 | RN242989
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License Number State | GA
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