Provider Demographics
NPI:1659724250
Name:REMSBERG, MARISA (AA)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:REMSBERG
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:BLACKMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:PO BOX 102163
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2163
Mailing Address - Country:US
Mailing Address - Phone:404-257-1415
Mailing Address - Fax:404-851-1649
Practice Address - Street 1:5665 PEACHTREE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1764
Practice Address - Country:US
Practice Address - Phone:404-257-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7060367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant