Provider Demographics
NPI:1548414618
Name:MARSHALL, SERENA
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:MARSHALL
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:PO BOX 44424
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30336-1424
Mailing Address - Country:US
Mailing Address - Phone:678-334-8040
Mailing Address - Fax:
Practice Address - Street 1:1102 WESTCHASE LN SW
Practice Address - Street 2:#307
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30336-4413
Practice Address - Country:US
Practice Address - Phone:678-334-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-15
Last Update Date:2008-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN073723164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse