Provider Demographics
NPI:1811040553
Name:PIRRAGLIA, MARISA
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:PIRRAGLIA
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 1:101 YORKTOWN DR
Mailing Address - Street 2:STE 100
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7663
Mailing Address - Country:US
Mailing Address - Phone:770-460-4285
Mailing Address - Fax:
Practice Address - Street 1:7460 WOLF RIVER BOULEVARD
Practice Address - Street 2:THE SUTHERLAND CARDIOLOGY CLINIC, P. C.
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-763-0200
Practice Address - Fax:901-260-1713
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2006008162363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN0000012313OtherMEDICAL LICENSE