Provider Demographics
NPI:1144509969
Name:WAUGH, MARLENE SOPHIA (AA-C)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:SOPHIA
Last Name:WAUGH
Suffix:
Gender:F
Credentials:AA-C
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:SOPHIA
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA-C
Mailing Address - Street 1:531 ROSELANE ST NW
Mailing Address - Street 2:#830
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6913
Mailing Address - Country:US
Mailing Address - Phone:770-794-0477
Mailing Address - Fax:770-794-3108
Practice Address - Street 1:677 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1101
Practice Address - Country:US
Practice Address - Phone:770-794-0477
Practice Address - Fax:770-794-3108
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant