Provider Demographics
NPI:1942088620
Name:FUSSELL, MARISSA ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ELIZABETH
Last Name:FUSSELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 CECIL RD
Mailing Address - Street 2:
Mailing Address - City:PEARSON
Mailing Address - State:GA
Mailing Address - Zip Code:31642-5124
Mailing Address - Country:US
Mailing Address - Phone:912-422-8647
Mailing Address - Fax:
Practice Address - Street 1:1111 US HIGHWAY 441 N
Practice Address - Street 2:
Practice Address - City:PEARSON
Practice Address - State:GA
Practice Address - Zip Code:31642-7340
Practice Address - Country:US
Practice Address - Phone:912-422-7073
Practice Address - Fax:912-422-7019
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN286894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN286894OtherADVANCED PRACTICE-NP