Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 048274 | GA |
NPI | 1518083617 |
---|---|
Provider Name | Patrice Y Marshall |
First Address | Decatur, GA 30033-5903 |
Second Address | Decatur, GA 30033-5903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 20/04/2021 |