Provider Demographics
NPI:1851474712
Name:MARRS, ELLEN JEAN I (RN)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:JEAN
Last Name:MARRS
Suffix:I
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:JEAN
Other - Last Name:KIMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1685 MAPLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2000
Mailing Address - Country:US
Mailing Address - Phone:770-476-7159
Mailing Address - Fax:
Practice Address - Street 1:1000JOHNSON FERRY RD. NE
Practice Address - Street 2:NORTHSIDE HOSPITAL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1704
Practice Address - Country:US
Practice Address - Phone:404-851-8906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN064152163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy