Provider Demographics
NPI:1649957325
Name:PINNOCK, MARIAN
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:PINNOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 MARKETPLACE BLVD # 1322
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5730
Mailing Address - Country:US
Mailing Address - Phone:754-244-6498
Mailing Address - Fax:
Practice Address - Street 1:1404 E FORREST AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-2710
Practice Address - Country:US
Practice Address - Phone:470-784-1161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
GA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)