Provider Demographics
NPI:1083871339
Name:MARIETTA NEWBORN CARE LLC
Entity Type:Organization
Organization Name:MARIETTA NEWBORN CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:770-235-2462
Mailing Address - Street 1:4295 COUNTRY GARDEN WALK
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152
Mailing Address - Country:US
Mailing Address - Phone:770-235-2462
Mailing Address - Fax:770-974-3955
Practice Address - Street 1:50 PLAZA WAY
Practice Address - Street 2:SUITE E
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:404-454-9716
Practice Address - Fax:770-793-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR065909363LN0000X
GAR047729364SN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatalGroup - Single Specialty
No364SN0000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeonatalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000585505BMedicaid
GA000585494BMedicaid