Provider Demographics
NPI:1548992332
Name:LEATHERS, MARJORIE (RN)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:LEATHERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 ANNIE MITCHELL DR SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-4865
Mailing Address - Country:US
Mailing Address - Phone:770-355-2922
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE STE B2200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-6577
Practice Address - Fax:404-778-8562
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN074620163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care