Provider Demographics
NPI:1992868236
Name:MARSHALL, MELANIE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 SAINT BARBARAS LN NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1450
Mailing Address - Country:US
Mailing Address - Phone:404-271-4884
Mailing Address - Fax:
Practice Address - Street 1:1295 HEMBREE RD
Practice Address - Street 2:BUILDING B, SUITE 100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5721
Practice Address - Country:US
Practice Address - Phone:770-772-0695
Practice Address - Fax:770-751-0409
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN132237367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA43BBDMLMedicare PIN