Provider Demographics
NPI:1043408438
Name:MARION, SAMUEL (CSA)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:MARION
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5881 GLENRIDGE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-8184
Mailing Address - Country:US
Mailing Address - Phone:404-303-7703
Mailing Address - Fax:044-303-7706
Practice Address - Street 1:5881 GLENRIDGE DR STE 120
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-8184
Practice Address - Country:US
Practice Address - Phone:404-303-7703
Practice Address - Fax:404-303-7706
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA2863363AS0400X, 246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist