Provider Demographics
NPI:1093767998
Name:PETERS, MARCIA JEAN (FNP,BC)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:JEAN
Last Name:PETERS
Suffix:
Gender:F
Credentials:FNP,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 HEATHERDOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3770
Mailing Address - Country:US
Mailing Address - Phone:404-372-7319
Mailing Address - Fax:404-471-6498
Practice Address - Street 1:141 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3770
Practice Address - Country:US
Practice Address - Phone:404-471-6348
Practice Address - Fax:404-471-6498
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN139529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily