Provider Demographics
NPI:1821182502
Name:HALL, MARYLIN DOREEN (NP-C)
Entity Type:Individual
Prefix:DR
First Name:MARYLIN
Middle Name:DOREEN
Last Name:HALL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1598 TWIN COURTS LN SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-7601
Mailing Address - Country:US
Mailing Address - Phone:404-226-9090
Mailing Address - Fax:770-333-0862
Practice Address - Street 1:1598 TWIN COURTS LN SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-7601
Practice Address - Country:US
Practice Address - Phone:404-226-9090
Practice Address - Fax:770-333-0862
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN088093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1821182502Medicare UPIN