Provider Demographics
NPI:1639580780
Name:GREEN, MARLA C (FNP-C)
Entity type:Individual
Prefix:MS
First Name:MARLA
Middle Name:C
Last Name:GREEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:477 WINDSOR ST SW STE 309
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-2530
Mailing Address - Country:US
Mailing Address - Phone:404-688-9202
Mailing Address - Fax:404-880-0838
Practice Address - Street 1:477 WINDSOR ST SW STE 309
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-2530
Practice Address - Country:US
Practice Address - Phone:404-688-9202
Practice Address - Fax:404-880-0838
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN196523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily