Provider Demographics
NPI:1326259243
Name:SMITH, MARLO P (NP)
Entity Type:Individual
Prefix:
First Name:MARLO
Middle Name:P
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARLO
Other - Middle Name:P
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 GREISON TRL STE F
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6401
Mailing Address - Country:US
Mailing Address - Phone:770-400-5660
Mailing Address - Fax:770-400-5799
Practice Address - Street 1:770 GREISON TRL STE F
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6401
Practice Address - Country:US
Practice Address - Phone:770-400-5660
Practice Address - Fax:770-400-5799
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN112907363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN112907OtherNURSING LICENSE