G

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

RN209845 Issued in GA

Legal business name

G

Practice address

55 Whitcher St NE
Marietta, GA 30060-1155

Phone

(770) 427-7389

Fax

(770) 427-1492

NPI assigned

Feb 22, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marietta Miller

Title

Administrator

Phone

(867) 388-1577

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Meredith Marie Evans, NP-C

  • Nurse Practitioner
  • Marietta, GA
  • NPI 1841892098
  NPD
• Kayla M. Cato, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Marietta, GA
  • NPI 1215479647
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487721600000",
    "number": "1215476304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WHITCHER ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601155",
            "telephone_number": "770-427-7389",
            "fax_number": "770-427-1492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 WHITCHER ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601155",
            "telephone_number": "770-427-7389",
            "fax_number": "770-427-1492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-22",
        "last_updated": "2017-02-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MARIETTA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "867-388-1577"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "GA",
            "license": "RN209845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "RN209845",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James A. Funderburk, M.A., LPC, NCC
• N. Roel Fung-a-Wing, P.T.
• Elisheva Ende Funk, LCSW
• Joan Rosen Funk, LCSW, PHD
• Whitney Gail Fuqua, DC
• G Singelton Gaston MD
• Ga CVS Pharmacy LLC (CVS Pharmacy)
• Ga Doctors of Optometry LLC (Visionworks)
• Ga Sothern Dental PPO (Natural Smiles Dentistry)
• Ga Southern Dental LLC (Georgia Dental Medicine)

• Acute Care Nurse Practitioner in Marietta, GA
• Providers in Marietta, GA by specialty
• Acute Care Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.