Provider Demographics
NPI:1952606303
Name:RANKIN, MARILYN (NP)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:RANKIN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:E
Other - Last Name:MATLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1203 WALKER CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8556
Mailing Address - Country:US
Mailing Address - Phone:470-220-0621
Mailing Address - Fax:229-485-1588
Practice Address - Street 1:62 MACON ST
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3221
Practice Address - Country:US
Practice Address - Phone:470-220-0621
Practice Address - Fax:229-485-1588
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD218147363LF0000X
VA0024177088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily