Provider Demographics
NPI:1548702566
Name:MCGRATH-ENI, MARCIA (NP)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:MCGRATH-ENI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 CLARKS CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-6576
Mailing Address - Country:US
Mailing Address - Phone:404-964-4704
Mailing Address - Fax:
Practice Address - Street 1:1275 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3433
Practice Address - Country:US
Practice Address - Phone:404-761-0819
Practice Address - Fax:404-768-2336
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN179820363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner