Provider Demographics
NPI:1336792886
Name:TIMMONS, MARCIA LANETTE (FNP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:LANETTE
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CARNEGIE PL STE 103
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-5900
Mailing Address - Country:US
Mailing Address - Phone:770-716-7999
Mailing Address - Fax:770-716-8444
Practice Address - Street 1:105 CARNEGIE PL STE 103
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-5900
Practice Address - Country:US
Practice Address - Phone:770-716-7999
Practice Address - Fax:770-716-8444
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN208133363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF06193081OtherNP CERTIFICATION NUMBER
GARN208133OtherFNP LICENSE