Provider Demographics
NPI:1255997847
Name:GAMBLE, MARISSA LEIGH (APRN-BC)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:LEIGH
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:MS
Other - First Name:MARISSA
Other - Middle Name:LEIGH
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703-7013
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:400 TIMMS RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-7016
Practice Address - Country:US
Practice Address - Phone:706-625-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-19
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176644363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily