Provider Demographics
NPI:1326415316
Name:HARGETT, MARION ELAINE
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:ELAINE
Last Name:HARGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 BROOKFOREST TRACE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034
Mailing Address - Country:US
Mailing Address - Phone:770-843-3217
Mailing Address - Fax:770-593-3217
Practice Address - Street 1:502 PRYOR STREET
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314
Practice Address - Country:US
Practice Address - Phone:770-593-3217
Practice Address - Fax:770-593-3217
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA306156103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst