MEDICARE: MARCIA MCGRATH-ENI N.P.

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	363L00000X	Nurse Practitioner	RN179820	GA

General Provider Information

NPI Number	:	1548702566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA MCGRATH-ENI N.P.

Provider Business Mailing Address
First Line	:	4702 CLARKS CREEK LN
Second Line	:
City	:	ELLENWOOD
State	:	GA
Zip	:	30294-6576
Country	:	US
Telephone Number	:	404-964-4704
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 CLEVELAND AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3433
Country	:	US
Telephone Number	:	404-761-0819
Fax Number	:	404-768-2336

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

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	04/06/2018

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