Provider Demographics
NPI:1861449928
Name:SLEMP, MARIETTA S (CPNP)
Entity Type:Individual
Prefix:
First Name:MARIETTA
Middle Name:S
Last Name:SLEMP
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 CENTURY BLVD NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3319
Mailing Address - Country:US
Mailing Address - Phone:404-633-4595
Mailing Address - Fax:404-633-6637
Practice Address - Street 1:1875 CENTURY BLVD NE
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3319
Practice Address - Country:US
Practice Address - Phone:404-633-4595
Practice Address - Fax:404-633-6637
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN054948363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00750648Medicaid