Provider Demographics
NPI:1578153235
Name:BERRY, KECIA MARSHALL (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KECIA
Middle Name:MARSHALL
Last Name:BERRY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7741 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4845
Mailing Address - Country:US
Mailing Address - Phone:404-612-2273
Mailing Address - Fax:
Practice Address - Street 1:7222 CAVENDER DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-9526
Practice Address - Country:US
Practice Address - Phone:404-200-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN229022163WC1500X, 363LP0808X
GA229022363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health