Provider Demographics
NPI:1639418163
Name:FARROW, MARILYNN L (MS, EIS)
Entity Type:Individual
Prefix:MRS
First Name:MARILYNN
Middle Name:L
Last Name:FARROW
Suffix:
Gender:F
Credentials:MS, EIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 TIMBER TRCE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8900
Mailing Address - Country:US
Mailing Address - Phone:770-815-2746
Mailing Address - Fax:770-592-6812
Practice Address - Street 1:1522 TIMBER TRCE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8900
Practice Address - Country:US
Practice Address - Phone:770-815-2746
Practice Address - Fax:770-592-6812
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129417AMedicaid