Provider Demographics
NPI:1972750685
Name:FISHER, MARY GRACE (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:FISHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 VISTAVIA CIR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3428
Mailing Address - Country:US
Mailing Address - Phone:404-633-2487
Mailing Address - Fax:
Practice Address - Street 1:141 PIEDMONT AVENUE, SUITE D
Practice Address - Street 2:GEORGIA STATE UNIVERSITY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-413-1940
Practice Address - Fax:404-413-1954
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN1299326363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health