Provider Demographics
NPI:1609070598
Name:FOSS, MERRY-LYNN (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MERRY-LYNN
Middle Name:
Last Name:FOSS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5003
Mailing Address - Country:US
Mailing Address - Phone:770-393-9852
Mailing Address - Fax:770-393-9852
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7694
Practice Address - Country:US
Practice Address - Phone:678-442-3317
Practice Address - Fax:678-442-4416
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118689363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care