Provider Demographics
NPI:1063534394
Name:PURCELL, MARY L (RN ACRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:PURCELL
Suffix:
Gender:F
Credentials:RN ACRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2191 ROCKBRIDGE RD
Mailing Address - Street 2:UNIT 1601
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3588
Mailing Address - Country:US
Mailing Address - Phone:770-469-0883
Mailing Address - Fax:404-508-7879
Practice Address - Street 1:440 WINN WAY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1715
Practice Address - Country:US
Practice Address - Phone:770-378-8932
Practice Address - Fax:404-508-7879
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN035462163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse