Provider Demographics
NPI:1841700382
Name:FEDERER, MARNI BELL (NP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARNI
Middle Name:BELL
Last Name:FEDERER
Suffix:
Gender:F
Credentials:NP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ROY RD
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-2584
Mailing Address - Country:US
Mailing Address - Phone:770-548-8807
Mailing Address - Fax:
Practice Address - Street 1:125 GOVERNORS SQ STE B
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4871
Practice Address - Country:US
Practice Address - Phone:770-603-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239041363LP0808X, 363LF0000X
FLAPRN11012190363LF0000X
AL1-157770363LP0808X
MARN2361712363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily