G NPI 1215476304

NPI Information

  • NPI: 1215476304
  • Provider Name: G
  • Classification: Nurse Practitioner - 363LA2100X
  • Specialization: Acute Care
  • Entity Type: Organization
  • CLIA Number: 11D1017785
  • Address: 55 WHITCHER ST NE
    MARIETTA, GA
    ZIP 30060
  • Phone: (770) 427-7389

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NPI Details

G is an acute care nurse practitioner in Marietta, GA. G NPI is 1215476304. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

55 WHITCHER ST NE
MARIETTA, GA
ZIP 30060-155
Phone: (770) 427-7389
Fax: (770) 427-1492

The provider's authorized official is Marietta Miller .
The authorized official title is Administrator and has the following contact phone number (867) 388-1577.

The CLIA number assigned to this NPI record is 11D1017785 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/22/2017 and was last updated on 2/22/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LA2100XNurse PractitionerAcute CareRN209845GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1RN209845OTHERGEORGIARN LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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