Provider Demographics
NPI:1952083321
Name:MCDERMOTT, MARJORIE L
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:L
Last Name:MCDERMOTT
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 1:3734 FOX HILLS DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4261
Mailing Address - Country:US
Mailing Address - Phone:240-408-1303
Mailing Address - Fax:
Practice Address - Street 1:1401 JOHNSON FERRY RD STE 390
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-9100
Practice Address - Country:US
Practice Address - Phone:470-250-1492
Practice Address - Fax:470-235-7311
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN242989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily