Provider Demographics
NPI:1710918917
Name:ELDER, MARIAN D (RN,MSN,APRN)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:D
Last Name:ELDER
Suffix:
Gender:F
Credentials:RN,MSN,APRN
Other - Prefix:MS
Other - First Name:DEE
Other - Middle Name:
Other - Last Name:ELDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN,MSN,APRN
Mailing Address - Street 1:PO BOX 33244
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-0244
Mailing Address - Country:US
Mailing Address - Phone:770-413-9364
Mailing Address - Fax:
Practice Address - Street 1:480 JOHN WESLEY DOBBS AVE NE
Practice Address - Street 2:UNIT 413
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-5324
Practice Address - Country:US
Practice Address - Phone:678-595-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN155777163W00000X, 163WC0400X, 364SP0809X
GARN1577163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult