Provider Demographics
NPI:1336102664
Name:CHRISTIAN, MARCIA (CRNA)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4090 FLINTLOCK RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3926
Mailing Address - Country:US
Mailing Address - Phone:314-378-3629
Mailing Address - Fax:
Practice Address - Street 1:150 N PARK TRL STE A
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7372
Practice Address - Country:US
Practice Address - Phone:770-507-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN127469367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA589632145BMedicaid
GA43BBBKLMedicare ID - Type Unspecified