Provider Demographics
NPI:1578240735
Name:MARVIN, CARSON HEATHERLY (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:CARSON
Middle Name:HEATHERLY
Last Name:MARVIN
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 EAGLES LANDING PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9200
Mailing Address - Country:US
Mailing Address - Phone:404-778-8605
Mailing Address - Fax:
Practice Address - Street 1:1050 EAGLES LANDING PKWY STE 200
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9200
Practice Address - Country:US
Practice Address - Phone:404-778-8605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN319716363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care