Provider Demographics
NPI:1225065154
Name:VUCHETICH, MARION ANGELICA (NP)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:ANGELICA
Last Name:VUCHETICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 EMORY CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1142
Mailing Address - Country:US
Mailing Address - Phone:404-616-6322
Mailing Address - Fax:404-616-9732
Practice Address - Street 1:341 PONCE DE LEON AVENUE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-616-6322
Practice Address - Fax:404-616-9732
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN035686363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner