Marianne Pettis
Nurse Practitioner, Family in Atlanta, GA. Individual provider (NPI-1).
NPI number1366057366
StatusActive
Last updated in NPPESSep 15, 2020
Details
- NPI
- 1366057366
- Entity type
- Individual (NPI-1)
- Name
- Marianne Pettis
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 15, 2020
- Certification date
- Sep 15, 2020
- Last updated
- Sep 15, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 218380 | GA | Yes |
Practice location
2429 Mlk Jr Dr SwAtlanta, GA 30311-1713
Phone 706-296-5739
Mailing address
2429 Martin Luther King Jr Dr SwAtlanta, GA 30311-1713
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