Active NPI
Marianne Pettis
- Family Nurse Practitioner
- Atlanta, GA
National Provider Identifier
1366057366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 218380
- Practice address
- 2429 MLK Jr Dr SW
Atlanta, GA 30311-1713 - Phone
- (706) 296-5739
- NPI assigned
- Sep 15, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 218380 | GA | Primary |
Addresses
Primary practice location
2429 MLK Jr Dr SW
Atlanta, GA 30311-1713
Mailing address
2429 Martin Luther King Jr Dr SW
Atlanta, GA 30311-1713
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 218380 | GA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600128000000",
"number": "1366057366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2429 MARTIN LUTHER KING JR DR SW",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303111713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2429 MLK JR DR SW",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303111713",
"telephone_number": "706-296-5739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIS",
"first_name": "MARIANNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-15",
"last_updated": "2020-09-15",
"certification_date": "2020-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "218380",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.