Provider Demographics
NPI:1609183755
Name:YOUNKER, MARCIA (APRN)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:YOUNKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BRIDGER POINT RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-5213
Mailing Address - Country:US
Mailing Address - Phone:404-915-3362
Mailing Address - Fax:770-631-1916
Practice Address - Street 1:825 S MULBERRY ST
Practice Address - Street 2:D
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-2474
Practice Address - Country:US
Practice Address - Phone:404-915-3362
Practice Address - Fax:770-631-1916
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN086363364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health