Provider Demographics
NPI:1043274806
Name:PARIS, MARY ROSE (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ROSE
Last Name:PARIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:21116 LAMPLIGHT DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30362
Mailing Address - Country:US
Mailing Address - Phone:770-645-2210
Mailing Address - Fax:
Practice Address - Street 1:3000 HOSPITAL BLVD
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4915
Practice Address - Country:US
Practice Address - Phone:770-751-2623
Practice Address - Fax:770-751-2627
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN128162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000829573AMedicaid
GA500015982OtherRR MEDICARE
GA000829573AMedicaid