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NPI Code Detail

MEDICARE: DAMALI MARSHALL FNP

MEDICARE: DAMALI MARSHALL FNP
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
1363LF0000XFamily Nurse Practitioner160719 NPGA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1202I506510OTHERGAPTAN

General Provider Information

NPI Number : 1942599014
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAMALI MARSHALL FNP
Provider Business Mailing Address
First Line : 3905 DUE WEST RD NW
Second Line :
City : MARIETTA
State : GA
Zip : 30064-1019
Country : US
Telephone Number : 678-290-5740
Fax Number :
Provider Business Practice Location Address
First Line : 3905 DUE WEST RD NW
Second Line :
City : MARIETTA
State : GA
Zip : 30064-1019
Country : US
Telephone Number : 678-290-5740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2011
Last Update Date : 11/04/2021

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