Provider Demographics
NPI:1477782399
Name:EARNHART, MARIA MAGDALENA
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:MAGDALENA
Last Name:EARNHART
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARIA
Other - Middle Name:MAGDALENA
Other - Last Name:ALLEGRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:524 AKERS RIDGE DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3217
Mailing Address - Country:US
Mailing Address - Phone:770-595-8851
Mailing Address - Fax:
Practice Address - Street 1:1255 HIGHWAY 54 W
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4526
Practice Address - Country:US
Practice Address - Phone:770-719-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant