Provider Demographics
NPI:1891719076
Name:HENRY, MARRE PATRICE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARRE
Middle Name:PATRICE
Last Name:HENRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MARRE
Other - Middle Name:PATRICE
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1126 PRESTON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8977
Mailing Address - Country:US
Mailing Address - Phone:678-583-5139
Mailing Address - Fax:
Practice Address - Street 1:2675 N DECATUR RD
Practice Address - Street 2:SUITE 506
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6131
Practice Address - Country:US
Practice Address - Phone:404-299-1679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant