Provider Demographics
NPI:1548840770
Name:ABEYTA, MARIJANE (NP)
Entity type:Individual
Prefix:
First Name:MARIJANE
Middle Name:
Last Name:ABEYTA
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 1:116 KASEY DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5228
Mailing Address - Country:US
Mailing Address - Phone:678-988-5680
Mailing Address - Fax:
Practice Address - Street 1:4255 WADE GREEN RD NW STE 925
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1762
Practice Address - Country:US
Practice Address - Phone:404-380-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN194923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily