Provider Demographics
NPI:1649518093
Name:POWELL-BRYAN, MARLENE (RN)
Entity type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:
Last Name:POWELL-BRYAN
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 1:2552 WESTCHESTER WAY SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6448
Mailing Address - Country:US
Mailing Address - Phone:770-760-1597
Mailing Address - Fax:
Practice Address - Street 1:2552 WESTCHESTER WAY SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6448
Practice Address - Country:US
Practice Address - Phone:770-760-1597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA122-R-1098374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide