MEDICARE: MS. MARIBEL NUNEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	13816	GA

General Provider Information

NPI Number	:	1184448169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIBEL NUNEZ

Provider Business Mailing Address
First Line	:	2693 PAXTON PL
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-6100
Country	:	US
Telephone Number	:	678-472-6454
Fax Number	:

Provider Business Practice Location Address
First Line	:	2693 PAXTON PL
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-6100
Country	:	US
Telephone Number	:	678-472-6454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2024
Last Update Date	:	02/20/2026

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