Provider Demographics
NPI:1205474715
Name:MARION PEDIATRICS AND ADOLESCENTS
Entity type:Organization
Organization Name:MARION PEDIATRICS AND ADOLESCENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MORRIS GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:PNP
Authorized Official - Phone:828-559-1227
Mailing Address - Street 1:31 E MEDICAL CT STE 1
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-4969
Mailing Address - Country:US
Mailing Address - Phone:828-559-1227
Mailing Address - Fax:
Practice Address - Street 1:31 E MEDICAL CT
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4969
Practice Address - Country:US
Practice Address - Phone:828-559-1227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty