Provider Demographics
NPI:1336405927
Name:MARCANTEL-NUGENT, LLC
Entity type:Organization
Organization Name:MARCANTEL-NUGENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCANTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-580-2408
Mailing Address - Street 1:3323 TURTLE LAKE CLUB DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5024
Mailing Address - Country:US
Mailing Address - Phone:404-580-2408
Mailing Address - Fax:
Practice Address - Street 1:3323 TURTLE LAKE CLUB DR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5024
Practice Address - Country:US
Practice Address - Phone:404-580-2408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARCANTEL-NUGENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033R0760253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care