Provider Demographics
NPI:1942833348
Name:RICHARD, MARJORIE (BNS,RN)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:RICHARD
Suffix:
Gender:F
Credentials:BNS,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 MCGEE RD STE C680
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-7017
Mailing Address - Country:US
Mailing Address - Phone:470-276-4490
Mailing Address - Fax:470-357-6577
Practice Address - Street 1:2140 MCGEE RD STE C680
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7017
Practice Address - Country:US
Practice Address - Phone:470-276-4490
Practice Address - Fax:470-357-6577
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHCP010389163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA831903856OtherPRIVATE HOME HEALTH CARE AGENCY