Provider Demographics
NPI:1376810895
Name:PARNELL-IVERY, MARISSA GENEVIEVE (CNP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:GENEVIEVE
Last Name:PARNELL-IVERY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 DUE WEST RD NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1019
Mailing Address - Country:US
Mailing Address - Phone:678-290-5740
Mailing Address - Fax:
Practice Address - Street 1:500 ASHWOOD PKWY BLDG E
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6906
Practice Address - Country:US
Practice Address - Phone:404-504-6554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.327547-COA1363LF0000X
GARN253366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily